A 9-year survival analysis of the presternal Missouri swan-neck catheter.

Peritoneal dialysis (PD) catheter survival is challenging because of infection and malfunction. The swan-neck presternal catheter has a coiled intra-abdominal segment with a bead and a flanged cuff at the peritoneum; a titanium adapter joins the abdominal segment to the upper segment. The upper segment has two cuffs, one on either side of the presternal swan-neck segment. The present study evaluated the survival of Missouri presternal swan-neck PD catheters implanted at the University of Missouri--Columbia and followed at Dialysis Clinics, Inc., through 2006. Catheter type and insertion date were prospectively recorded. Survival was defined as the interval from insertion date to date of removal, censoring, or analysis. Catheters were censored for transplant, death, or transfer to another unit. A total of 131 presternal catheters were implanted in 129 patients. Mean patient age was 60.9 +/- 16.3 years. No catheters were removed during the first 3 months for either infection or technical problems. One catheter was removed at 6 months for malposition and another at 2 years for an external leak; all other catheter losses were attributable to peritonitis. Cumulative catheter survival was 93.5%, 82.5%, 63.9%, and 60.0% at 1, 2, 3, and 4 years respectively. The mean observation period was 19. 7 +/- 17.8 months, and the longest catheter survival was 87.5 months. New episodes of peritonitis were 91 in number, a rate of 1 episode per 28 patient-months. Although catheter survival exceeded the recommendation of better than 80% at 1 year, we noted a trend toward lower catheter survival and a higher peritonitis rate than were reported earlier in this series with a smaller number of catheters. That trend is partly explained by repeated episodes of peritonitis in 11 catheters; 8.5% of the patients experienced 40% of the peritonitis episodes.