Cuff Shaving Procedure for Distal Cuff Erosion in Peritoneal Dialysis Patients – Three-Year Follow-up

Abstract Background Erosion of the distal cuff of peritoneal dialysis (PD) catheters can lead to exit site infections, tunnel infections, peritonitis, and often culminates in catheter loss, necessitating catheter replacement or permanent transition to hemodialysis (HD). Surgical shaving of the distal cuff has been reported as an alternative option for management of distal cuff erosion. In this paper, we report promising results of a three year follow up study of a patient with distal cuff erosion who was treated with surgical shaving of the distal cuff. Methods We performed a retrospective review for a patient with end stage renal disease (ESRD) who uses PD, who had documented subclinical erosion of the PD cuff and was managed with surgical shaving of the eroded portion. The PD catheter was originally inserted by a vascular surgeon with the outer cuff implanted subcutaneously, approximately 2–3 cm away from the exit site. The patient did not experience any post-surgical complications following catheter insertion. The PD catheter was in use for more than one year prior to erosion. Shaving of the distal cuff was performed and the patient’s case was reviewed over a period of 3 years. Results We identified a patient with distal cuff erosion for whom the cause of erosion was documented as mechanical force. The patient was noted to have normal function of their PD catheter at the time of diagnosis without any signs or symptoms of infection. Over a period of 3 years after cuff shaving, there were no episodes of exit-site infection, tunnel infection, or peritonitis. The patient experienced excellent catheter function following surgical shaving, and throughout follow up. Conclusion Shaving of the distal Dacron cuff is a viable option for the management of select peritoneal dialysis patients with erosion of the distal cuff of the catheter. This treatment modality has the potential to reduce the incidence of catheter related infections, spare patients from surgical complications related to catheter removal and replacement, and prevent a permanent transition to hemodialysis due to cuff erosion.