Abstract
Purpose
To determine the safety and effectiveness of tunneled peritoneal catheters in the management of refractory malignant and non-malignant ascites.
Materials and Methods
An IRB-approved retrospective review was undertaken of patients who underwent ultrasound and fluoroscopy-guided tunneled peritoneal catheter placement for management of refractory malignant or non-malignant ascites between January 1, 2009, and March 14, 2014.
Results
A total of 137 patients (76 M/61 F, mean age 62.9 years) underwent tunneled peritoneal catheter placement for refractory malignant (N = 119; 86.9%) or non-malignant (N = 18; 13.1%) ascites. Technical success was 100% with no immediate complications. Nineteen patients (13.9%) experienced a total of 11 minor and 12 major complications. Nine patients developed a catheter-associated infection. The remaining complications included leakage at the dermatotomy site (N = 8), catheter dislodgement (N = 2), obstruction (N = 2), and groin pain (N = 2). Patients who developed a catheter-associated infection had a significantly longer catheter dwell time compared to those who did not develop an infection (median, 96.5 vs. 20 days; p < 0.01). Nine patients (6.6%) were lost to follow-up. Of the remaining 128 patients, 125 died and the majority had a catheter in place (90.4%) at the time of death. There was one catheter-associated death (bacterial peritonitis; 0.8%). The median time from catheter placement to death was significantly shorter in patients with malignant versus non-malignant ascites (18.5 vs. 85 days; p < 0.0001).
Conclusions
Tunneled peritoneal drainage catheters are effective and relatively safe in the management of malignant and non-malignant ascites. Longer catheter dwell time may be a risk factor for catheter-associated infection, particularly in patients with a longer anticipated survival in the palliative setting.
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References
Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut. 2006;55(Suppl 6):vi1–12.
Markman M. Palliation of symptomatic malignant ascites: an (often) unmet need. Oncology. 2012;82(6):313–4.
Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42(5):589–97.
Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330(5):337–42.
Ross GJ, Kessler HB, Clair MR, et al. Sonographically guided paracentesis for palliation of symptomatic malignant ascites. AJR Am J Roentgenol. 1989;153(6):1309–11.
Runyon BA. Paracentesis of ascetic fluid: a safe procedure. Arch Intern Med. 1986;146:2259–61.
Mallory A, Schaefer JW. Complications of diagnostic paracentesis in patients with liver disease. JAMA. 1978;239:628–30.
De Gottardi A, Thevenot T, Spahr L, et al. Risk of complications after abdominal paracentesis in cirrhotic patients: a prospective study. Clin Gastroenterol Heptol 2009;7(8):906-909.
Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg 2004;198(6):999-1011.
Gines P, Arroyo V, Vagas V, et al. Paracentesis with intravenous infusion of albumin as compared with peritoneovenous shunting in cirrhosis with refractory ascites. N Engl J Med 1991;325(12):829-835.
Stanley MM, Ochi S, Lee KK, et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. N Engl J Med. 1989;321(24):1632–8.
Salerno F, Camma C, Enea M, et al. Transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis of individual patient data. Gastroenterology. 2007;133(3):825–34.
Copelan A, Kapoor B, Sands M. Transjugular intrahepatic portosystemic shunt: Indications, contraindications, and patient work-up. Semin Interv Radiol. 2014;31(3):235–42.
Stokes LS. Peritoneal management of malignant fluid collections. Semin Interv Radiol. 2007;24(4):398–408.
Narayanan G, Pezeshkmehr A, Venkat S, et al. Safety and efficacy of the PleurX catheter for the treatment of malignant ascites. J Palliat Med. 2014;17(8):906–12.
Wong BC, Cake L, Kachuik L, et al. Indwelling peritoneal catheters for managing malignancy associated ascites. J Palliat Care. 2015;31(4):243–9.
Richard HM 3rd, Coldwell DM, Boyd-Kranis RL, et al. PleurX tunneled catheter in the management of malignant ascites. J Vasc Interv Radiol. 2001;12(3):373–5.
Tapping CR, Ling L, Razack A. PleurX drain use in the management of malignant ascites: safety, complications, long-term patency and factors predictive of success. Br J Radiol. 1013;2012(85):623–8.
Courtney A, Nemcek AA, Rosenberg S, et al. Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. J Vasc Interv Radiol. 2008;19(12):1723–31.
Fleming ND, Alvarez-Secord A, Von Gruenigen V, et al. Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manage. 2009;38(3):341–9.
Barnett TD, Rubins J. Placement of a permanent tunneled peritoneal drainage catheter for palliation of malignant ascites: a simplified percutaneous approach. J Vasc Interv Radiol. 2002;13(4):379–83.
Lungren MP, Charles CY, Stewart JK, et al. Tunneled pertioneal drainage catheter placement for refractory ascites: single-center experience in 188 patients. J Vasc Interv Radiol 2013;24(9):1303-1308.
Solbach P, Honer Zu Siederdissen C, Taubert R, et al. Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis. Eur J Gastroenterol Hepatol. 2017;29(5):539–46.
Sacks D, McClenny TE, Cardella JF, et al. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14(9 Pt 2):S199–202.
Lacy JH, Wieman TJ, Shively EH. Management of malignant ascites. Surg Gynaecol Obstet. 1984;159:397–412.
Rosenberg S, Courtney A, Nemcek AA, et al. Comparison of percutaneous management techniques for recurrent malignant ascites. J Vasc Interv Radiol. 2004;15(10):1129–31.
Bohn KA, Ray CE. Repeat large-volume paracentesis versus tunneled peritoneal catheter placement for malignant ascites: a cost-minimization study. AJR Am J Roentgenol. 2015;205(5):1126–34.
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Dr. Woodrum reports personal fees from Galil Medical and personal fees from CLS Medical, outside the submitted work.
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For this type of study, formal consent is not required. All study subjects had a Minnesota Research Authorization allowing use of medical records for research purposes.
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Knight, J.A., Thompson, S.M., Fleming, C.J. et al. Safety and Effectiveness of Palliative Tunneled Peritoneal Drainage Catheters in the Management of Refractory Malignant and Non-malignant Ascites. Cardiovasc Intervent Radiol 41, 753–761 (2018). https://doi.org/10.1007/s00270-017-1872-1
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DOI: https://doi.org/10.1007/s00270-017-1872-1