Tunneled peritoneal drainage catheter placement for refractory ascites: single-center experience in 188 patients

Purpose: To assess the success and safety of tunneled peritoneal drainage catheters for the management of ascites refractory to medical management.

Materials and methods: A total of 188 consecutive patients (83 male, 105 female; average age 59 y) with refractory ascites were treated with tunneled peritoneal drainage catheters from January 1, 2006, to August 10, 2012. A combination of fluoroscopic and ultrasound guidance was used to insert all catheters. Patient history, procedural records, and clinical follow-up documents were retrospectively reviewed. Clinical data (malignancy, renal disease, chemotherapy, neutropenia, albumin levels) were compared with respect to patency and complication rates with the use of odds ratios. Catheter survival curves were generated with the Kaplan-Meier method and life-table analysis for the cumulative and infection-free survival of primary and secondary catheters.

Results: A total of 193 catheter placements or interventions were performed in 188 patients with refractory ascites: 170 catheters (93%) were placed for malignant etiologies and 13 (7%) for nonmalignant etiologies. The most common malignancies were ovarian (22%), pancreatic (12%), and breast (11%). The most common nonmalignant etiologies were end-stage liver disease (n = 7) and heart failure (n = 6). There was a 100% technical success rate for catheter insertion; no procedure-related deaths or major placement complications were identified. Catheter survival ranged from 0 to 796 days (mean, 60 d), with a total of 11,936 cumulative catheter-days. Fourteen postplacement complications were identified: five patients experienced catheter malfunction, four had leakage of ascites at the incisional site requiring suture placement, three had cellulitis of the tunnel tract, and two developed peritonitis. The annual complication event rate was 0.43 events per year (ie, 0.12 events per 100 catheter-days). Pancreatic malignancy was associated with a significantly increased rate of catheter malfunction (ie, occlusion).

Conclusions: Radiologic insertion of tunneled peritoneal drainage catheters demonstrated a 100% technical success rate for insertion and an acceptable complication rate for the management of refractory ascites.