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Acute peritoneal dialysis following ruptured abdominal aortic aneurysms
H Hajarizadeh1, M J Rohrer, J B Herrmann
1Division of Vascular Surgery, University of Massachusetts Medical Center, Worcester 01655, USA.
American Journal of Surgery
|August 1, 1995
Summary
Peritoneal dialysis catheters can be safely placed after ruptured abdominal aortic aneurysm repair to provide early dialysis for acute renal failure. This method also aids in diagnosing intra-abdominal bleeding and infection.
Area of Science:
- Nephrology
- Vascular Surgery
- Critical Care Medicine
Background:
- Acute renal failure is a common complication following ruptured abdominal aortic aneurysm (AAA) repair.
- Hemodialysis (HD) is often poorly tolerated in critically ill patients due to hemodynamic instability and anticoagulation risks.
- Peritoneal dialysis (PD) offers a gentler alternative, avoiding cardiopulmonary stress and anticoagulation, but was previously contraindicated due to abdominal wounds and aortic grafts.
Purpose of the Study:
- To evaluate the safety and efficacy of early peritoneal dialysis (PD) catheter placement in patients undergoing repair of ruptured abdominal aortic aneurysms (AAA).
- To assess the utility of PD catheters in managing acute renal failure and diagnosing complications in this high-risk patient population.
Main Methods:
- A retrospective review of 105 patients who underwent ruptured AAA repair between 1982 and 1993.
- Peritoneal dialysis catheters were placed in 69 patients with criteria including shock, oliguria, or preoperative renal insufficiency.
- The study evaluated the safety and effectiveness of initiating early dialysis via PD catheters.
Main Results:
- Acute tubular necrosis occurred in 31 patients, with 19 requiring dialysis. PD alone or combined with hemofiltration/HD was effective in 58% of these patients.
- PD catheters facilitated early diagnosis of peritonitis in 5 patients and intra-abdominal hemorrhage in 4 patients.
- Complications included bacterial peritonitis in 3 patients (17%) and one late aortic graft infection; abdominal wound dehiscence occurred in two patients but without PD use. Catheter placement did not impact survival.
Conclusions:
- Placing a PD catheter during ruptured AAA repair is safe and facilitates early, effective dialysis for patients at risk of acute renal failure.
- The PD catheter serves as a valuable tool for the early detection of intraperitoneal bleeding and infection.
- This approach offers a viable option for renal replacement therapy in a challenging surgical population.