Outcomes of Fluoroscopic Tenckhoff Catheter Repositioning: Impact of Etiology of Malfunction and Preprocedural Catheter Position

Background: Peritoneal dialysis (PD) is the most common modality of renal replacement therapy in Hong Kong because of the "PD-First" policy. Catheter malfunction remains a significant clinical challenge. Fluoroscopic repositioning is a minimally invasive procedure for patients with catheter malfunction refractory to conservative management. This technique is safe, rapid, and allows immediate resumption of PD post-procedure. However, evidence on the impact of malfunction etiology and pre-procedural catheter position on outcomes remains limited. Methods: This retrospective analysis included 32 consecutive PD patients from 2022 to 2024, with catheter malfunction refractory to conservative measures. Fluoroscopic repositioning using a double guidewire technique was performed. Clinical outcomes were analysed for all patients, with comparisons between omental wrap and migration groups, and evaluation of pre-procedural catheter tip position (pelvic vs. non-pelvic). Success (restored dialysate flow) was evaluated at 1 and 3 months. Results: Mean age was 58.3 ± 16.5 years, 53.1% male. No intergroup differences in age, sex, BMI, time to malfunction (median 21[IQR8–103]d), repositioning delay (median 27[IQR15–49]d) or surgical history (p > 0.05). Overall success was 46.9% (15/32) at 1month, 43.8% (14/32) at 3months. Etiology-driven outcomes revealed significantly higher 1-month success for migration (85.7% [6/7]) versus omental wrap (33.3% [8/24]; p=0.009), with sustained durability at 3 months (71.4% [5/7] vs. 33.3% [8/24]; p=0.07). Non-pelvic catheters trended toward higher 1-month success (55.0% [11/20] vs. 33.3% [4/12]; p=0.30), with all migration cases originating from non-pelvic positions (p<0.001). 93.3% (14/15) of 1-month successes persisted at 3 months. No complications occurred. Conclusion: Fluoroscopic Tenckhoff Catheter Repositioning is a safe procedure with 46.9% overall success at 1 month, demonstrating 93.3% durability at 3 months for initial successes. It is particularly effective for migrated catheters (85.7% 1-month success). Catheter tip located at non-pelvic region before procedure trended toward better outcomes (55.0% vs. 33.3%), aligning with migration etiology. Omental wrap’s low success (33.3%) advocates for adjunctive strategies, e.g. surgical intervention. These findings emphasize etiology-driven management to optimize technique survival.