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Kidney Week

Abstract: PO0982

Severe Bleeding and Deep Inferior Epigastric Pseudoaneurysm After PD Catheter Removal

Session Information

  • Peritoneal Dialysis
    November 04, 2021 | Location: On-Demand, Virtual Only
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Matthews, Nicola, St. Michael's Hospital, Toronto, Ontario, Canada
  • Glavinovic, Tamara, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • Auguste, Bourne L.A, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Introduction

In this case, the removal of a PD catheter with deep cuff calcification results in pseudoaneurysm formation with hemorrhage and hospitalization.

Case Description

A 24-year-old woman with end-stage kidney disease was switched from PD to HD due to worsening uremia and PD catheter removal was organized. At the time of catheter removal heavy calcification around the deep Dacron cuff embedded into the rectus muscle was seen. Upon catheter removal, the deep inferior epigastric perforating (DIEP) vessel was sheared, creating a pseudoaneurysm where urgent angiographic embolization to stop the bleeding was needed (Fig. 1). Intimate relationship between DIEP vessel and Dacron cuff was felt to be secondary to heavy calcification of these structures that developed during her time on PD (Table 1). The patient required an urgent transfusion and was admitted to hospital for monitoring. She was discharged the following day in stable condition.

Discussion

This is an important learning case in PD catheter removal and highiglights the following:
-Poorly controlled bone mineral disease may lead to excessive calcification of the deep Dacron cuff and DIEP vessels.
-When heavy calcification of the PD cuff is seen, catheter removal should be done in settings equipped with interventional radiology support in the event of complication.

Calcium-phosphate balance while on PD
 Month 1Month 2Month 3Month 5Month 7
Creatinine (mg/dL)17.213.811.312.014.5
Urea (mg/dL)75.178.167.266.785.7
Phosphate (mmol/L)3.282.181.921.952.43
Calcium (mmol/L)2.552.552.592.512.45
Albumin (g/L)3537383835
PTH (pmol/L)175.3100.488.5106.8103.6

Enter Cell Value

Pseudoaneurysm (red arrow) and hemorrhage of prominent DIEP vessel after PD catheter removal.