ACUTE PERITONEAL-DIALYSIS FOLLOWING RUPTURED ABDOMINAL AORTIC-ANEURYSMS

BACKGROUND: Acute renal failure is common after repair of ruptured abd ominal aortic aneurysm. Early dialysis has recently been advocated to reduce the mortality associated with multiorgan failure, but hemodialy sis (HD) is not well-tolerated in critically ill patients because of h emodynamic instability and risk of bleeding from anticoagulation thera py, Peritoneal dialysis (PD) has the advantage in that it causes minim al cardiopulmonary instability and does not require anticoagulation. T he presence of a freshly-closed abdominal wound and an aortic graft, h owever, have previously been considered to be contraindications to PD. METHODS: Peritoneal dialysis catheters were placed in 69 of the 105 p atients who underwent grafting for a ruptured abdominal aortic aneurys m between 1982 and 1993, Criteria for placement included shock, periop erative oliguria, and preoperative renal insufficiency, All charts wer e reviewed retrospectively to evaluate the safety and efficacy of plac ing PD catheters and initiating early dialysis in patients at risk for developing acute renal failure. RESULTS: Acute tubular necrosis devel oped in 31 patients, 19 of whom required dialysis, Peritoneal dialysis alone provided effective dialysis in 8 patients, and it was combined with hemofiltration and/or HD in 9 additional patients for an overall efficacy of 58%. The peritoneal catheter also facilitated the early di agnosis of peritonitis due to colon ischemia in 5 patients, and was he lpful in diagnosing intra-abdominal hemorrhage in 4 others. Bacterial peritonitis occurred in 3 (17%) patients undergoing PD with no cause n oted for the infection other than use of the PD catheter, A single aor tic graft infection was diagnosed 4.2 years postoperatively with an en teric organism in a patient with recurrent diverticulitis, Two patient s with peritoneal catheters developed abdominal wound dehiscence, but neither had undergone PB (P >0.2), In a multivariate analysis, placeme nt of a PD catheter did not affect survival, CONCLUSIONS: Placement of a PD catheter at the time of resection of a ruptured abdominal aortic aneurysm in patients at risk for development of acute renal failure i s without significant complications and can facilitate early and effec tive dialysis, The peritoneal dialysis; catheter may also be useful in making an early diagnosis of intraperitoneal bleeding and infection.