Experiences with minimally invasive techniques for peritoneal dialysis (PD) catheter placement are being increasingly described. Percutaneous placement of catheters using ultrasound and fluoroscopic guidance has reduced the risk of complications and has led to successful long-term catheter function. An interventional radiology catheter placement capability was established at our facility and it serves as the basis for this report.We performed a retrospective analysis of patients in a tertiary care center in Northern California who required PD between July 2005 and October 2008. Patients underwent PD catheter placement in an interventional radiology suite by the radiologist using a percutaneous Seldinger technique that was guided by fluoroscopy.Sixty-four patients between the ages of 25 and 90 were referred for fluoroscopic PD catheter placement by an interventional radiologist. If clinically indicated, PD was initiated within days of catheter placement. Minor complications were noted: four with minor bleeding, three with catheter migration, and one with temporary exit-site leakage. No bowel or bladder perforations were encountered.Fluoroscopically guided PD catheter placement by interventional radiologists can be a safe and cost-effective strategy to initiate acute or chronic PD. This approach could reduce the need for temporary vascular access and expedite the initiation of PD therapy by eliminating the delays in catheter placement often associated with surgical consultation and operating room scheduling.

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DESCRIPTIONA man aged 46 years presented with gradually progressive weakness of bilateral lower limbs and reduced sensation below the level of nipple for the past 2 months. There was no history of upper limb weakness and his bowel and bladder movements were normal. On enquiry, he also has a 2-year history of dry cough, wheeze and exertional dyspnoea. He is a non-smoker with no other significant medical history. On examination, power of bilateral lower limbs was 0/5, and knee and ankle reflexes were brisk with extensor plantar response. The patient had decreased sensation below the level of D5 vertebra. He had bilateral occasional

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