1
|
Swinnen J“J, Baker L, Burgess D, Allen R, O’Grady A, Chau K. Changing the peritoneal dialysis access algorithm with a precise technique of percutaneous Seldinger PD catheter placement. J Vasc Access 2022; 23:615-623. [DOI: 10.1177/11297298221077607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: In 1953, Swedish radiologist Sven Seldinger introduced a technique for blood vessel or hollow organ access using a needle, guide wire and catheter. Over the last two decades, this technique has been used for Peritoneal Dialysis (PD) catheter placement, “Seldinger PD” (SPD). To improve the safety and accuracy of SPD, ultrasound, X-ray guidance, contrast imaging and micropuncture techniques have been incorporated to a greater or lesser extent. Methods: This manuscript describes a new and rigorous technique of SPD developed at our unit and results in the first 64 cases. One of our goals was to replace emergency Central Vein Catheter Hemodialysis with “Urgent-Start” PD. We therefore sought to develop a procedure that was ultra-safe, minimally invasive and readily done on the sickest patients under Local Anesthetic. As the technique was new to our unit, and because of progressive modifications of the technique, some of the results reflect our “learning curve.” In addition, 55% of the patients referred to our program had “crashed” into renal failure, 32% were deemed “unfit for General Anaesthesia” by the Anaesthetists and 53% were moderately to severely obese, resulting in a very morbid and vulnerable cohort. Results: Despite this, we had no procedure related mortality, no organ injury and no significant bleeding. Technical success was 97% (intention-to-treat). Urgent Start PD was used in 36%; overall, 3/61 catheters placed experienced PD fluid leak. Correct catheter tip placement – in the Pelvic Pouch – was documented in all cases; significant catheter migration was seen in 18% of those with imaging follow-up, only two requiring revision. Most catheter migrations occurred early in our series before our low peritoneal puncture technique became standard. Conclusions: We believe this SPD technique is safe, precise, clinically and financially cost-effective and can replace other forms of PD placement in most situations.
Collapse
Affiliation(s)
- Jan “John” Swinnen
- Vascular Surgery, Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Luke Baker
- Radiology Department, Westmead Hospital, Sydney, NSW, Australia
- Notre Dame University, Darlinghurst, NSW, Australia
| | - David Burgess
- Cardiology, Blacktown Hospital, Blacktown, NSW, Australia
- Western Sydney University, Penrith, NSW, Australia
| | - Richard Allen
- Vascular Surgery, Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Allan O’Grady
- Radiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Katrina Chau
- Western Sydney University, Penrith, NSW, Australia
- Nephrology, Blacktown Hospital, Blacktown, NSW, Australia
| |
Collapse
|
2
|
Swinnen J“J, Hitos K, Kairaitis L, Gruenewald S, Larcos G, Farlow D, Huber D, Cassorla G, Leo C, Villalba LM, Allen R, Niknam F, Burgess D. Multicentre, randomised, blinded, control trial of drug-eluting balloon vs Sham in recurrent native dialysis fistula stenoses. J Vasc Access 2018; 20:260-269. [DOI: 10.1177/1129729818801556] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Endovascular treatment of autogenous arteriovenous haemodialysis fistula stenosis has high reintervention rates. We investigate the effect of drug-eluting balloons in the treatment of recurrent haemodialysis fistula stenosis. Methods: This is a randomised, controlled, investigator-initiated and run, prospective, blinded, multicentre trial. Patients with recurrent autogenous arteriovenous haemodialysis fistula stenosis received standard endovascular treatment plus drug-eluting balloon or standard endovascular treatment plus uncoated balloon (Sham). Primary endpoint was late lumen loss in trial area on ultrasound at 6 weeks, 3, 6 and 12 months. Secondary endpoints were freedom from reintervention to the Index Trial Area and decline in fistula flow (Qa). Interim analysis was performed at 6 months (unblinded due to timeliness). Results: Patients with 132 recurrent stenoses (48% in bare Nitinol stents) were randomised with 70 receiving drug-eluting balloon and 62 Sham. At 6 months, decline in late lumen loss was 0.23 ± 0.03 mm/month for Sham and 0.045 ± 0.03 mm/month for drug-eluting balloon arm, a significant difference (0.18 mm, p = 0.0002). At 12 months, this difference persisted at 0.12 mm (p = 0.0003). At 6 months, significant difference in late lumen loss for instent restenoses (p = 0.0004) was observed, with non-significant difference for unstented restenoses (p = 0.065). Mean time for freedom from reintervention was 10.14 months for Sham versus 42.39 months for drug-eluting balloon (p = 0.001). The same was shown for instent (p = 0.014) and unstented (p = 0.029) restenoses. Qa decline rate at 6 months was 36.89 mL/min/month (Sham) and 0.41 mL/min (drug-eluting balloon). The difference was significant (36.48 mL/min; p = 0.02) and persisted to 12 months (p = 0.44). Conclusion: Paclitaxel drug-eluting balloon significantly delays restenosis after angioplasty for recurrent autogenous arteriovenous haemodialysis fistula stenosis, persisting to 12 months. Drug-eluting balloon significantly increases freedom from reintervention at 12 months with these effects true in stented and unstented fistulas.
Collapse
Affiliation(s)
- Jan “John” Swinnen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Lukas Kairaitis
- Western Renal Service, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Simon Gruenewald
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - George Larcos
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Farlow
- Department of Nuclear Medicine & Ultrasound, Westmead Hospital, Westmead, NSW, Australia
| | - David Huber
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Gabriel Cassorla
- Clínica Alemana de Santiago and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christopher Leo
- Renal Centre, University Medicine Cluster, National University Hospital, Singapore
| | - Laurencia M Villalba
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - Richard Allen
- Department of Surgery, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Farshid Niknam
- Department of Surgery, University of Wollongong, Wollongong Hospital, Wollongong, NSW, Australia
| | - David Burgess
- Department of Cardiology, Western Sydney University, Blacktown Hospital, Blacktown, NSW, Australia
| |
Collapse
|