Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study

Maher, Emad, Wolley, Martin J., Abbas, Saib A., Hawkins, Stewart P. and Marshall, Mark R. (2014) Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study. Journal of Vascular and Interventional Radiology, 25 6: 895-903. doi:10.1016/j.jvir.2014.01.023

Author Maher, Emad
Wolley, Martin J.
Abbas, Saib A.
Hawkins, Stewart P.
Marshall, Mark R.
Title Fluoroscopic versus laparoscopic implantation of peritoneal dialysis catheters: a retrospective cohort study
Journal name Journal of Vascular and Interventional Radiology   Check publisher's open access policy
ISSN 1535-7732
Publication date 2014-06-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.jvir.2014.01.023
Open Access Status Not yet assessed
Volume 25
Issue 6
Start page 895
End page 903
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Formatted abstract
Purpose: A previous clinical trial showed that radiologic insertion of first peritoneal dialysis (PD) catheters by modified Seldinger technique is noninferior to laparoscopic surgery in patients at low risk in a clinical trial setting. The present cohort study was performed to confirm clinical effectiveness of radiologic insertion in everyday practice, including insertion in patients with expanded eligibility criteria and by fellows in training.

Materials and Methods: Between 2004 and 2009, 286 PD catheters were inserted in 249 patients, 133 with fluoroscopic guidance in the radiology department and 153 by laparoscopic surgery. Survival analyses were performed with the primary outcome of complication-free catheter survival and secondary outcomes of overall catheter survival and patient survival. Outcomes were assessed at last follow-up, as long as 365 days after PD catheter insertion.

Results: In the radiologic group, unadjusted 365-day complication-free catheter, overall catheter, and patient survival rates were 22.6%, 81.2%, and 82.7%, respectively, compared with 22.9% (P =.52), 76.5% (P =.4), and 92.8% (P =.01), respectively, in the laparoscopic group. Frequencies of individual complications were similar between groups. Adjusting for patient age, comorbidity, and previous PD catheter, the hazard ratio (HR) for catheter complications by radiologic versus laparoscopic insertion is 0.90 (95% confidence interval [CI], 0.62-1.31); the HR for overall catheter survival is 1.25 (95% CI, 0.59-2.65); and that for death is 2.47 (95% CI, 0.84-7.3).

Conclusions: Radiologic PD catheter insertion is a clinically effective alternative to laparoscopic surgery, although there was poorer long-term survival with radiologic catheter placement, possibly because of preferential selection of radiologic insertion for more frail patients.
Keyword Radiology, Nuclear Medicine & Medical Imaging
Peripheral Vascular Disease
Radiology, Nuclear Medicine & Medical Imaging
Cardiovascular System & Cardiology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 6 times in Thomson Reuters Web of Science Article | Citations
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