A Laparoscopic Method for Optimal Peritoneal Dialysis Access

2005 ◽  
Vol 71 (2) ◽  
pp. 135-143 ◽  
Author(s):  
John H. Crabtree ◽  
Arnold Fishman
Keyword(s):  
Peritoneal Dialysis ◽  
Financial Incentives ◽  
Rectus Sheath ◽  
Laparoscopic Approach ◽  
Dialysis Access ◽  
Medical Benefits ◽  
Implantation Techniques ◽  
Procedural Complications ◽  
Modality Variable

Both medical benefits to the patient and financial incentives to the health care system exist to increase the use of peritoneal dialysis as renal replacement therapy. Providing long-term peritoneal access free of mechanical dysfunction continues to represent a major challenge to the success of this modality. Variable outcomes result from the lack of standard implantation methodology and failure to address persistent problems associated with current implantation techniques. This prospective case study compared noninfectious procedural complications of three approaches to establish peritoneal dialysis access. The groups consisted of 63 catheters implanted by traditional open dissection, 78 catheters implanted by basic laparoscopy without associated interventions, and 200 catheters implanted by advanced laparoscopic methods including rectus sheath tunneling, selective prophylactic omentopexy, and selective adhesiolysis. Mechanical flow obstruction, the major outcome indicator, followed only 1 of 200 (0.5%) implantation procedures in the advanced group and was significantly better ( P < 0.0001) than the open dissection (17.5%) and basic laparoscopic (12.5%) groups. A low rate of pericannular leaks (1.3–2%) was not different for the three groups. One pericannular hernia occurred in the open group. Catheter mechanical dysfunction attributable to the surgical technique can nearly be eliminated through adjunctive procedures made possible only by a laparoscopic approach.

A Laparoscopic Approach under Local Anesthesia for Peritoneal Dialysis Access

2000 ◽  
Vol 20 (6) ◽  
pp. 757-765 ◽  
Author(s):  
John H. Crabtree ◽  
Arnold Fishman
Keyword(s):  
Peritoneal Dialysis ◽  
Local Anesthesia ◽  
Rectus Sheath ◽  
Laparoscopic Approach ◽  
Dialysis Access ◽  
Catheter Survival ◽  
Simultaneous Identification ◽  
Port Device ◽  
Port Location

Objective Presented herein is a technical description of a time-proven laparoscopic approach to establishing successful long-term peritoneal dialysis access. Design Using a two-port technique, the peritoneal catheter is inserted through a paramedian port site while continuously monitoring the implant procedure with a laparoscope from a second port location. A long rectus sheath tunnel created with a nontrocar port device keeps the dialysis catheter oriented toward the pelvis. Helium abdominal insufflation enables full surgical laparoscopy under local anesthesia. Validation of the effectiveness of the technique is made by comparison to previous implantation experience using an open dissection method. Patients Laparoscopic implantation of peritoneal catheters was performed in 150 patients, and placement by open dissection was accomplished in 63 patients. Main Outcome Measure The incidence of complications and revision-free catheter survival between implantation methods were compared. Results Catheters implanted laparoscopically had a significantly lower incidence of flow dysfunction ( p < 0.05) and better survival ( p < 0.001) than those placed by open dissection. Conclusions Compared to implantation by open dissection, the laparoscopic approach provides the patient reduced perioperative discomfort. The procedure can be performed safely with the patient under local anesthesia on an ambulatory basis. Laparoscopic implantation significantly reduces the incidence of catheter flow dysfunction and permits simultaneous identification and correction of other problems that could complicate dialysis therapy.

Effective use of laparoscopy for long-term peritoneal dialysis access

2009 ◽  
Vol 198 (1) ◽  
pp. 135-141 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Access ◽  
Effective Use

Effect of Prior Abdominal Surgery, Peritonitis, and Adhesions on Catheter Function and Long-Term Outcome on Peritoneal Dialysis

2009 ◽  
Vol 75 (2) ◽  
pp. 140-147 ◽  
Author(s):  
John H. Crabtree ◽  
Raoul J. Burchette
Keyword(s):  
Peritoneal Dialysis ◽  
Laparoscopic Approach ◽  
Catheter Insertion ◽  
Peritoneal Dialysis Catheter ◽  
Previous Surgery ◽  
Visceral Injury ◽  
Long Term Outcome ◽  
Catheter Survival ◽  
Prior Surgery

Adhesions from previous surgery and peritonitis can lead to peritoneal dialysis catheter insertion failure, visceral injury, and poor dialysis function. Employing a laparoscopic approach, the effect of adhesiolysis on mechanical catheter complications and long-term catheter survival was prospectively examined in 436 catheter placement procedures having a 57.8 per cent prevalence rate of previous surgery. Adhesiolysis was required in 31.8 per cent of cases with prior surgery and in 3.3 per cent of procedures without previous operations. The incidence of adhesiolysis was directly related to the number of prior surgeries ( P < 0.0001). The incidence of catheter insertion failure from extensive adhesions was 1.8 per cent. Survival probability free from catheter obstruction was lower in patients requiring adhesiolysis compared with subjects with prior surgery not requiring adhesiolysis ( P = 0.01). Laparoscopic rescue procedures limited catheter losses from flow obstruction to only 0.7 per cent. As a result, long-term catheter survival was not different among patients regardless of prior surgery and/or adhesion status ( P = 0.2). Scars on the abdomen and prior peritonitis do not predict the extent of adhesions and should not be used to judge eligibility for peritoneal dialysis. Presently, laparoscopy is the only practical way to provide optimal peritoneal access in patients with a history of surgery and peritonitis.

Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis

2017 ◽  
Vol 37 (4) ◽  
pp. 414-419 ◽  
Author(s):  
Emily J. See ◽  
Yeoungjee Cho ◽  
Carmel M. Hawley ◽  
Lauren R. Jaffrey ◽  
David W. Johnson
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Insertion ◽  
First Episode ◽  
Dialysis Access ◽  
Complication Rates ◽  
Early Complication ◽  
Free Survival ◽  
Technique Survival ◽  
Catheter Migration

BackgroundSignificant interest in the practice of urgent-start peritoneal dialysis (PD) is mounting internationally, with several observational studies supporting the safety, efficacy, and feasibility of this approach. However, little is known about the early complication rates and long-term technique and peritonitis-free survival for patients who start PD urgently (i.e. within 2 weeks of catheter insertion), compared to those with a conventional start.MethodsThis single-center, matched case-control study evaluated patients commencing PD between 2010 and 2015. Urgent-start PD patients were matched 1:3 with conventional-start PD controls based on diabetic status and age. The primary outcomes were early complications, both following catheter insertion and PD commencement (within 4 weeks). Secondary outcomes included technique and peritonitis-free survival.ResultsA total of 104 patients (26 urgent-start, 78 conventional-start) were included. Urgent-start patients were more likely to be referred late, initiate PD in hospital, and be prescribed lower initial exchange volumes ( p < 0.01). They experienced more frequent leaks post-catheter insertion (12% vs 1%, p = 0.047) and more frequent catheter migration following commencement of PD (12% vs 1%, p = 0.047). There were no significant differences in the rates of overall or infectious complications. Kaplan-Meier estimates of technique survival and time to first episode of peritonitis were comparable between the groups.ConclusionCompared with conventional-start PD, urgent-start PD has acceptably low early complication rates and similar long-term technique survival. Urgent-start PD appears to be a safe way to initiate urgent renal replacement therapy in patients without established dialysis access.

scholarly journals Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Delin Wang ◽  
Nathan Calabro-Kailukaitis ◽  
Mahmoud Mowafy ◽  
Eric S Kerns ◽  
Khetisuda Suvarnasuddhi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Cohort ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Central Venous ◽  
The Usa ◽  
The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average &gt;1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P &lt; 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

Plasma fluoride concentration in infants receiving long-term peritoneal dialysis

1989 ◽  
Vol 115 (3) ◽  
pp. 436-439 ◽  
Author(s):  
Bradley A. Warady ◽  
Mark Koch ◽  
Durl W. O'Neal ◽  
Marian Higginbotham ◽  
David J. Harris ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Fluoride Concentration

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

2021 ◽  
pp. 089686082199692
Author(s):  
Vasilios Vaios ◽  
Panagiotis I Georgianos ◽  
Georgia Vareta ◽  
Dimitrios Divanis ◽  
Evangelia Dounousi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Pulse Wave ◽  
Age Dependence ◽  
End Stage Kidney Disease ◽  
End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

Effectiveness and safety of repeated percutaneous intervention in an office-based endovascular center in maintaining hemodialysis access

Vascular ◽  
2021 ◽  
pp. 170853812110043
Author(s):  
Jay Patel ◽  
Stephanie Chang ◽  
Shaan Manawar ◽  
John Munn ◽  
Mark C Rummel ◽  
...  
Keyword(s):  
Percutaneous Intervention ◽  
Dialysis Access ◽  
Arteriovenous Graft ◽  
Hemodialysis Access ◽  
Upper Arm ◽  
Access Site ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
The Mean

Objectives Percutaneous dialysis access interventions are routinely used to maintain the patency of dialysis access despite the lack of data regarding their long-term effectiveness. This retrospective study was undertaken to study the effectiveness and safety of percutaneous dialysis access interventions in arm fistulas and bridge grafts in an office-based endovascular center. Methods Patients who had a percutaneous dialysis access intervention in their upper extremity access site, performed at a single office-based endovascular center over a nine-year period (2007–2016) were included in this study. The patients’ demographic factors, patency, and complications were analyzed. Patients were entered in the study after first percutaneous dialysis access intervention. Results A total of 298 limbs in 259 patients had 913 procedures carried out over a nine-year period. There were 190 access arteriovenous fistulas and 108 arteriovenous grafts. The two most common arteriovenous fistulas were the brachiocephalic fistula ( n = 74, 39%) and radio cephalic fistula ( n = 69, 36%). Arteriovenous grafts were most commonly placed in the upper arm ( n = 66, 61%) followed by the forearm ( n = 42, 39%). The mean overall patency for all limbs was 50.86 months. Arteriovenous fistulas had a significantly longer patency than arteriovenous grafts (51.65 vs. 42.09 months; P = 0.01). In addition, patients with two or more percutaneous dialysis access intervention in their arteriovenous fistula had significantly greater patency than those with only one percutaneous dialysis access intervention (58.5 vs. 7.6 months; hazard ratio 0.41; P = 0.0008). This was not true for the arteriovenous graft group. Women represented 49% of the patient group. Their accesses had shorter patency than men (39.8 vs. 60 months; P = 0.0007). Conclusions This data support the use of repeated percutaneous dialysis access intervention to maintain long-term patency of dialysis access sites in an office-based endovascular center. Overall, fistulas have longer patency than grafts and women have poorer outcomes as compared to men

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