关键词: 腹膜透析, 数字减影血管造影, 导管移位, 导丝

Abstract:  Objective:To evaluate the technical feasilility and safety of using a 0.035-inch super-slippery stiff guidewire to reposition displaced peritoneal dialysis (PD) cathetersunder real-time digital subtraction angiography (DSA) guidance. Methods:We conducted a retrospective analysisof the clinical data of 32 PD patients diagnosed with peritoneal catheter malposition by kidney-ureter-bladder (KUB) radiography at the Second Affiliated Hospital of Soochow University from January 2021 to July 2022. A 0.035-inch super-slipperystiff guidewire was used to reposition the PD catheter under real-time DSA guidance, We calculated the success rate of repositioning, summarized the causes of failure, recorded the procedure time and X-ray fluoroscopy time, documented related complications, and followed up catheter patency and PD- related peritonitis for 12 months. Results:Successful repositioning of the PD catheter tip into the true pelvis was achieved in 30 of the 32 patients, yielding a primary success rate of93.75%. Repositioning failed in two patients. In the first patient, abdominal computed tomography (CT) revealed thatthe catheter was located between intestinal loops with its tip in the retroperitoneal space; repeated attempts failed to advancee it into the true pelvis. In the second patient, although the catheter was initially advanced into the true pelvis, contrast innjection showed localized pooling around the catheter tip, and dialysate drainage was slow. Laparoscopy confirmed omentalwrapping around the catheter. The mean procedure time was26.3+7.4 min, and the mean fluoroscopy time was 11.52.2 min. During the procedure, three patients experienced mild abdominal pain or discomfort. No PD-related peritonitis occurred immediately after the procedure. Four patients reported nausea and discomfort postoperatively. No other procedure-related complications were observed. During the 12- month follow-up, one of the 30 successfully repositioned patients experienced catheter remigration, while the remaining 29 maintained unobstructed drainage without recurrent migrationor PD-associated peritonitis. Conclusion: The technique of repositioning displaced PD catheters using a 0.035-inch supper-slippery stiff guidewire under real-time DSA guidance is technically feasible, safe, minimally invasive, and associatedwith short procedure time and no major complications. For PD catheters that cannot be repositioned by conventional methods, this approach can avoid the trauma of open surgical revision and is worthy of further clinical promotion.