Efficacy and safety of fluoroscopic manipulation using the alpha-replacer for peritoneal catheter malposition

Background Catheter malposition is one of the reasons for outflow failure in peritoneal dialysis (PD) patients. Fluoroscopic manipulation is a non-surgical treatment option for catheter malposition. We retrospectively analyzed the efficacy and safety of fluoroscopic manipulation using an alpha-replacer guidewire. Methods The alpha-replacer (JMS Co. Ltd., Tokyo, Japan) is a guidewire for the treatment of catheter malposition. We used the alpha-replacer in 23 PD cases at our hospital from January 2008 to December 2012. We evaluated body mass index, time interval between catheter placement and malposition, and interval between catheter exteriorization and malposition. Primary failure was defined as malposition at the time of catheter exteriorization, and secondary failure as malposition after functional PD therapy (correct position at time of exteriorization). Results Successful catheter replacement rate using the alpha-replacer was 60.8 % (14 of 23 cases). This was similar to the rates in previous reports. Successful replacement was mostly observed in those with a long interval between catheter placement and malposition ( p = 0.048), between catheter placement and exteriorization ( p = 0.047) and with secondary failure ( p = 0.030). In multivariate analysis, secondary failure cases had a higher rate of successful replacement than primary failure cases (odds ratio [OR] 7.33, p = 0.038). Serious complications, such as abdominal trauma or peritonitis, were not observed. Conclusion Fluoroscopic manipulation using an alpha-replacer may be safe and effective for the management of peritoneal catheter malposition, particularly in patients who were under functional PD therapy until catheter malposition.