Fr Catheter Research Articles

Safety and Effectiveness of the Novel Catheter 3.0 System for Diagnostic Cerebral Angiography: A Pilot Study.

The purpose of this study was to evaluate the safety and effectiveness of a new angiographic system (Catheter 3.0 system) using a 5 French (Fr), large-bore angiography catheter, a 0.032-inch stiff guidewire, and a continuous flushing system in diagnostic cerebral angiography. This retrospective study included 30 consecutive patients who underwent transfemoral cerebral angiography using the Catheter 3.0 system from October 2019 to March 2020. As the control group, we included 30 consecutive patients examined before the Catheter 3.0 system was introduced. Procedural outcomes, including technical success, procedure time, dose metrics, procedure-related complications, and image quality were reviewed and analyzed. All transfemoral cerebral angiographies were performed for a diagnosis of unruptured intracranial aneurysms. The Catheter 3.0 system showed a significantly shorter fluoroscopy time (6.2 vs. 9.7 minutes, P=0.008) and lower fluoroscopy dose (387.2 vs. 614.4, P=0.002) compared with the conventional 4-Fr catheter system. The Catheter 3.0 system also showed better results in terms of procedural time (21.0 vs. 22.5 minutes, P=0.072) and technical success rate (98.1% vs. 94.0%, P=0.078), although a statistical significance was not reached. The complication rate and qualitative assessment of the digital subtraction angiography (DSA) image quality were similar between the two groups. The Catheter 3.0 system using a 5 Fr catheter with a large inner diameter was convenient, effective, and safe compared with the conventional system in diagnostic cerebrovascular angiography.

Comparing Left Internal Mammary Angiography via Right Radial or Femoral Access With a Single-Catheter Technique

BackgroundWe compared the safety and effectiveness of left internal mammary artery (LIMA) angiography through right radial (Rad) or femoral (Fem) artery access with a single-catheter technique. MethodsLIMA selective imaging was attempted through Rad access with a Bartorelli-Cozzi 5.2Fr catheter in 190 consecutive patients. They were compared with 190 consecutive patients in whom LIMA was imaged with a mammary catheter via Fem access. Successful LIMA imaging within 15 min and time needed for imaging were efficacy end-point. Safety metrics were cerebral ischemic events and access site complications. ResultsOverall success rate of Rad LIMA imaging was 62 %. The success rate of Fem LIMA imaging was 97 %. In Rad group, patient age emerged as the single independent correlate of success at multivariate analysis (OR 9.938, CI 0.902–0.977 p = 0.002), with 77 % success rate in the lowest age quartile (<67 years).Median time needed to obtain selective LIMA imaging was significantly longer in Rad than in Fem (5.5 min vs. 4.0 min, p < 0.001), but right radial access was not a significant predictor of time needed to image LIMA at multivariate analysis (K 0.726, CI [−0.130–1.581], p = 0.09). Access site complications (6 vs. 0 cases, p = 0.030), and clinically significant bleeding (4 vs. 0 cases, p = 0.1) occurred in Fem group only.No peri-procedural cerebrovascular events were seen in either Group. ConclusionsRight radial artery is a suboptimal, yet reasonable access for LIMA-graft selective imaging in younger patients. The technique is free from vascular complications and peri-procedural cerebrovascular events.

Ultrasound-Guided Intravascular Sonothrombolysis With a Dual Mode Ultrasound Catheter: In Vitro Study.

Thromboembolism in vessels often leads to stroke or heart attack and even sudden death unless brought under control. Sonothrombolysis based on ultrasound contrast agents has shown promising outcome in effective treatment of thromboembolism. Intravascular sonothrombolysis transducer was reported recently for unprecedented sonothrombolysis in vitro. However, it is necessary to provide an imaging guide during thrombolysis in clinical applications for optimal treatment efficiency. In this article, a dual mode ultrasound catheter was developed by combining a 16-MHz high-frequency element (imaging transducer) and a 220-kHz low-frequency element (treatment transducer) for sonothrombolysis in vitro. The treatment transducer was designed with a 20-layer PZT-5A stack with the aperture size of 1.2×1.2 mm2, and the imaging transducer with the aperture size of 1.2×1.2 mm2 was attached in front of the treatment transducer. Both transducers were assembled into a customized 2-lm 10-Fr catheter. In vitro experiment was carried out using a bovine blood clot. Imaging tests were conducted, showing that the backscattering signals can be obtained with a high signal-to-noise ratio (SNR) for the 16-MHz imaging transducer. Sonothrombolysis was performed successfully that the volume of clot was reduced significantly after the 30-min treatment. The size changes of clot were observed clearly using the 16-MHz M-mode imaging during the thrombolysis. The findings suggest that the proposed ultrasound-guided intravascular sonothrombolysis can be enhanced since the position of treatment transducer can be adjusted with the target at the clot due to the imaging guide.

Long-term Follow-up and Success Rate of Ventral Inlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease

ObjectiveTo determine the long-term success of ventral inlay buccal-mucosal graft urethroplasty (Vi-BMGU) for female urethral strictures (FUS). Materials and MethodsWe performed a retrospective analysis of prospectively maintained data on patients who underwent Vi-BMGU between May 2016 and January 2020 with a minimum follow-up of 2 years. The primary outcome was the long-term success after 2 to 5 years of surgery. Patients were followed with American Urological Association (AUA) symptom score, uroflowmetry, and post-void residual (PVR) urine measurement. Failure (recurrence) was defined by an increase in the AUA symptoms score by 3 on subsequent follow-up visits and maximum flow rate (Qmax) <12 cc/s and inability to calibrate with an 18 Fr catheter. ResultsTwenty-one patients were included. The Median follow-up was 42 months (range: 24-64 months). The AUA symptom scores, Qmax, and PVR, improved in all except 3 patients. The median AUA score fell from 27 (range 18-34) at diagnosis to 9 (range 6-24), at the last follow-up. Similarly, the median PVR values decreased from 138 ml (34-290) to 24 ml (19-360) and the mean Qmax improved from 7.7 ± 2.2 ml/s to 22.6 ± 5 ml/s. None experienced urinary incontinence. There were 2 failures, 1 at 6 months and the other at 24 months. The overall success rate was 90.5 %. Success rates on life table analysis were 95%, 85%, 85%, 85%, and 85% after 1, 2, 3, 4 and 5 years respectively. ConclusionThe 95% success at 1 year and 85% sustained success at 2 to 5 years of follow-up establishes the long-term success of Vi-BMGU.

PO-696-06 REAL-WORLD EXPERIENCE WITH A NOVEL 3D INTRACARDIAC ECHOCARDIOGRAPHY CATHETER

Intracardiac echocardiography (ICE) is a valuable imaging modality which allows real-time visualization of cardiac anatomy for procedural guidance. The NUVISION™ 4D ICE catheter (Biosense Webster Inc, Irvine, CA) is a novel 10-Fr catheter with fully sampled matrix phased-array transducer capable of real-time 3D imaging. A unique feature of the catheter is the presence of a dedicated knob, which allows independent 360° rotation of the tip. To describe the performance of the NUVISIONTM catheter during different electrophysiology procedures. We included 50 consecutive patients scheduled for electrophysiology procedures between September and November 2021. The primary endpoint was a composite of safety (device-related complications) and efficacy (acute procedural success). A 5-point Likert scale was used to rate the experience with transseptal (TS) access, catheter maneuverability, image quality. Among 50 patients (mean age 70±11, 22% female), 38 (76%) underwent left atrial appendage (LAA) occlusion, 6 (12%) AF ablation, 3 (6%) VT/PVC ablation, and 3 (4%) LAA leak closure with either coils (n=1; 2%) or radiofrequency applications (n=2; 4%). The ICE catheter was advanced through an 11-Fr sheath into the left femoral vein; no access-related complications occurred. TS access was performed in 47 patients (single access: 14 pts; double access: 33 pts). Mean time for each TS access was 3.4±0.7 min; ICE catheter performance during TS was rated as “very good” in 87.2% of cases. Maneuverability was rated as “very good” in 84% of cases; of note, the percentage of “very good” ratings rose from 72% to 96% between the first and the last 25 cases, as a result of the better familiarity and increasing satisfaction of the operators with the rotation knob. The catheter was advanced into the left atrium in 38 LAA procedures. A multiplanar view (Figure 1) was the imaging modality of choice (81.6%) for LAA sizing and during device deployment. A single device was attempted in all patients; 4 patients required device recapture and repositioning. Image quality was rated as “very good” in 98% of cases. No device-related complications occurred; acute procedural success was achieved in all. The NUVISIONTM 3D ICE catheter was safe and may significantly improve procedural guidance.

PO-637-02 PRECLINCIAL FEASIBILITY OF LINEAR ABLATION USING A FOCAL PULSED FIELD ABLATION CATHETER INTEGRATED WITH AN ELECTROANATOMICAL MAPPING SYSTEM

‘One-shot’ pusled field ablations (PFA) catheters that are capable of pulmonary vein isolation are currently being evaluated and can have significant impact on procedural efficiency. However, there is a need for delivering flexible lesions sets as well with PFA, that address more advanced forms of atrial fibrillation and atypical flutters. An 8 Fr catheter (Farapoint, Boston Scientific) capable of delivering focal PFA has been developed to allow for delivery of various lesion sets by using a 3-D mapping system (Rhythmia, Boston Scientific).

PO-626-08 LEFT ATRIAL APPENDAGE OCCLUSION WITH LEFT ATRIAL FOUR DIMENSIONAL INTRACARDIAC ECHOCARDIOGRAPHY

Left atrial appendage occlusion, using intracardiac echocardiography (ICE) continues to evolve. One of the more recent advancements is the Siemens 4-D ACUSON AcuNav Volume ICE® (Siemens, Malvern PA). This catheter allows for 4D images to optimize the provider’s implant visibility and minimize the maneuvers required to assess the LAA. Although right atrial imaging has been more commonly described, left atrial 4-D ICE imaging may allow for better unobstructed imaging. Demonstrate implant technique using 4-D ICE (ACUSON AcuNav Volume ICE®, Siemens, Malvern PA) guided LAAO using optimal left atrial imaging. The 4-D ICE catheter is a 12.5 Fr catheter that is initially guided into the RA to assist in navigating transspetal puncture. The probe obtains a field of view which is 90 degrees by 50 degrees with frame rate of 16 volumes per second. The catheter visualizes the septum/fossa ovalis for transseptal puncture. Following successful puncture, the ICE catheter and LAAO Sheath can be guided through a single puncture with fluoroscopic and 4-D ICE guidance. Using multiplanar reconstruction, 4-D ICE requires a single catheter position to visualize the entirety of the left atrial appendage. We evaluate the mid left atrium with posterior flexion and counterclockwise rotation to visualize the LAA ostium. Multiplanar reconstruction can be manipulated to demonstrate the enface LAA ostium view the maximal length of the appendage. The landing zone dimensions are calculated using the reconstructions (Figure 1). Once the LAA has been appropriately visualized, the Watchman access sheath is advanced to the LA. Cineangiographic images of the LAA are obtained and the Watchman device is sized and delivered. Our single center experience has recorded more than 75 successful LAAO implants using this 4D ICE left atrial imaging technique. The advancement in visibility and ability to get a thorough assessment of the LAA, without complex manipulation of a 2-D ICE or TEE probe is ideal. The evolution of ICE with 4-D technology has allowed for an improved imaging experience during implant, especially when imaging from within the left atrium.

V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER

You have accessJournal of UrologyCME1 May 2022V06-12 LAPAROSCOPIC MITROFANOFF APPENDICOVESICOSTOMY: AN OPTION IN COMPLEX ADULT PATIENT TO ACCESS TO THE BLADDER Roberto Hugo Martinez Rodriguez, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Fatima Castroviejo, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Fatima CastroviejoFatima Castroviejo More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Mitrofanoff principle was originally described in paediatric population as a method to provide an alternative access to the bladder. It creates a conduit to the bladder through which patients with a sensitive, absent or traumatized urethra can perform clean intermittent catheterization (CIC) easily. We report our experience with complete laparoscopic approach in an adult patient with complex urogenital malformation and multiple previous surgeries. METHODS: 39 years old female patient born with urogenital sinus plus anorectal atresia and bicornuate uterus with several reconstructive surgeries during neonatal and infant period. Previous to the surgery, the patient was performing several CIC per day with increasing difficulty, pain and urethrorrhagia. The patient was incontinent due to elevate post-voiding residue due to an ineffective evacuation by catheter. Low bladder pressure was confirmed by urodynamics. Pelvic MRI showed atypical morphology of the bladder after previous surgery plus cystic image in the right iliac fossa related to anexial cyst without visualizing the anal sphincter complex. RESULTS: A 4 port transperitoneal approach was used :2 of 10 mm laparoscopic ports and 2 of 5 mm ports. The 10 mm camera port was placed trough the umbilicus and the rest in the midline and lateral to the edge of the rectus abdominis muscle. After liberation of several abdominal adherences, we found the appendix and right hemicolon medially and cranially displaced. The appendix was harvested with preservation of the vascular supply and ligated at its base. The appendix was assessed to determine whether the length was adequate to reach the anterior abdominal wall. The bladder was filled with saline and a 3 cm vertical seromuscular incision was made in the right posterior wall of the bladder down to the mucosa. Appendicovesical anastomosis was then performed, and seromuscular layer of the bladder was closed creating a tunnel for the appendix. The tightness of the bladder anastomosis was tested by bladder filling. Care was taken to ensure absence of twisting or tension on the appendiceal mesentery. The appendix was then brought up to the abdominal wall and a catheterizable stoma was created with 8 Fr catheter left through the appendix. The operative time was 300 min and estimated blood loss was 120 cc. The patient was discharged at eighth day. CONCLUSIONS: Pure laparoscopic Mitrofanoff appendicovesicostomy is feasible in adult patients even with previous and complicated surgeries. Pure laparoscopic Mitrofanoff is associated with reasonable outcome, early recovery and good cosmesis. The main disadvantage is the long operative time due to anatomical challenges. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e568 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Fatima Castroviejo More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bridge Using the Hemolung System for Re-Do Double Lung Transplant In Situs Inversus Patient

IntroductionExtracorporeal life support (ECLS) use in redo-lung transplant is limited due to poor outcomes. Extracorporeal circulation with a single cannula provides the advantage of mobility and effective rehabilitationn in patients with an expected long run. The Hemolung veno-venous extracorporeal carbon dioxide removal (ECCO2R) system allows for adequate removal of carbon dioxide with a small French double lumen catheter.Case ReportA 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Her postoperative course was uneventful. After an aspiration event, she experienced a severe and persistent decline in her lung function within her first year. She ultimately was hospitalized requiring mechanical ventilation and a tracheostomy. The patient had primarily hypercapnic respiratory failure with radiographic signs of CLAD. The need for a high respiratory rate led to increased calory consumption with a significant impact on her BMI. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with ECLS. The use of an Avalon cannula was limited by her anatomy as the outflow jet will point against the atrial wall. Dual site cannulation was deemed suboptimal to preserve mobility. We decided to proceed with a Hemolung after emergency FDA authorization. A dual-lumen 15.5Fr catheter was placed via the left IJ into the superior vena cava. As we normalized her CO2 by active ECCO2R removal, we were able to reduce her ventilatory needs, improve her nutritional status and mobility. She was listed and underwent an uneventful redo-double lung transplant with cardiopulmonary support. The patient is 200 days out and doing well.SummaryThis experience demonstrates that ECCO2R technologies can be safely and effectively used to bridge lung transplant patients with hypercapnic respiratory failure in which anatomical challenges limit cannulation options. Extracorporeal life support (ECLS) use in redo-lung transplant is limited due to poor outcomes. Extracorporeal circulation with a single cannula provides the advantage of mobility and effective rehabilitationn in patients with an expected long run. The Hemolung veno-venous extracorporeal carbon dioxide removal (ECCO2R) system allows for adequate removal of carbon dioxide with a small French double lumen catheter. A 29-year-old female with Kartagener syndrome and complete situs inversus underwent a double lung transplant for end stage lung disease. Her postoperative course was uneventful. After an aspiration event, she experienced a severe and persistent decline in her lung function within her first year. She ultimately was hospitalized requiring mechanical ventilation and a tracheostomy. The patient had primarily hypercapnic respiratory failure with radiographic signs of CLAD. The need for a high respiratory rate led to increased calory consumption with a significant impact on her BMI. To optimize her nutritional status and muscle strength before re-do lung transplantation, we decided to bridge her with ECLS. The use of an Avalon cannula was limited by her anatomy as the outflow jet will point against the atrial wall. Dual site cannulation was deemed suboptimal to preserve mobility. We decided to proceed with a Hemolung after emergency FDA authorization. A dual-lumen 15.5Fr catheter was placed via the left IJ into the superior vena cava. As we normalized her CO2 by active ECCO2R removal, we were able to reduce her ventilatory needs, improve her nutritional status and mobility. She was listed and underwent an uneventful redo-double lung transplant with cardiopulmonary support. The patient is 200 days out and doing well. This experience demonstrates that ECCO2R technologies can be safely and effectively used to bridge lung transplant patients with hypercapnic respiratory failure in which anatomical challenges limit cannulation options.

Technical Success of the GoBack™ Crossing Catheter in Chronic Total Occlusion in Patients with Chronic Limb Threatening Ischemia.

To assess the technical success of GoBack™ crossing catheter in chronic total occlusion. A retrospective review of chronic limb threatening ischemia (CLTI) patients treated for chronic total occlusions (CTO) with the application of the GoBack™ crossing catheter (Upstream Peripheral Technologies, Haifa, Israel) between May 2020 and January 2021 was performed. Sixteen GoBack catheters were applied in twelve limbs in 12 patients (ten men, average age 75.7years). Treated limbs were classified as Rutherford Category 5 and 6 in ten patients and four in two patients. Average occlusion length was 287mm (62-466). All occluded arteries were heavily calcified. Technical success was defined as successful application of the GoBack catheter for lesion crossing or luminal reentry. Successful application of the four French catheter was achieved in 11 of the 12 cases (92%) for reentry in external iliac (1), superficial femoral (2), popliteal (2) and posterior tibial (1) arteries in six out of six cases (100%) and lesion crossing in popliteal (4), peroneal (1) and posterior tibial arteries in five out of six cases (83%). The 2.9 Fr catheter was successfully applied once out of four (25%) in lesion crossing in the posterior tibial artery. The GoBack™ 4 Fr crossing catheter in revascularization of CLI patients with CTO could be valuable when manual crossing or reentry is unsuccessful and is applicable from any access site.

Percutaneous delivery of self-propelling hemostatic powder for managing non-compressible abdominal hemorrhage: a proof-of-concept study in swine

IntroductionNon-compressible intra-abdominal hemorrhage (NCIAH) is a major cause of preventable death on the battlefield and in civilian trauma. Currently, it can only be definitively managed with surgery, as there are limited strategies for controlling ongoing NCIAH in the prehospital environment. We hypothesized that a self-propelling thrombin-containing powder (SPTP) could increase survival in a swine model of NCIAH when delivered percutaneously into the closed abdomen using an engineered spray system. Materials and MethodsNineteen swine underwent surgical laparotomy followed by a Grade V liver injury that created massive hemorrhage, before closing the abdomen with sutures. Animals either received treatment with standard of care fluid resuscitation (n=9) or the SPTP spray system (n=10), which consisted of a spray device and a 14 Fr catheter. Using the spray system, SPTP was delivered into a hemoperitoneum identified using a focused assessment with sonography in trauma (FAST) exam. Lactated Ringer's solution was administered to all animals to maintain a mean arterial pressure (MAP) of >50 mmHg. The primary outcome was percentage of animals surviving at three hours following injury. ResultsIn the swine model of NCIAH, a greater percentage of animals receiving SPTP survived to three hours, although differences were not significant. The SPTP spray system increased the median survival of animals from 1.6 hr in the fluid resuscitation group to 4.3 hr. The SPTP spray system delivered a total mass of 18.5 ± 1.0 g of SPTP. The mean change in intra-abdominal pressure following SPTP delivery was 5.2 ± 1.8 mmHg (mean ± SEM). The intervention time was 6.7 ± 1.7 min. No adverse effects related to the SPTP formulation or the spray system were observed. SPTP was especially beneficial in animals that had either severely elevated lactate concentrations or low mean arterial pressure of <35 mmHg shortly after injury. ConclusionsThis demonstrates proof-of-concept for use of a new minimally invasive procedure for managing NCIAH, which could extend survival time to enable patients to reach definitive surgical care.

Pancreatic hemorrhage contributes to late mortality in patients with acute necrotizing pancreatitis

ObjectivesThe frequency, risk factors, and impact on survival of hemorrhage into (peri)pancreatic collections in patients with acute pancreatitis (AP) has not been well studied. The study was designed to evaluate the risk factors for hemorrhage, successful hemostasis and its effect on in-hospital mortality. MethodsIn a prospective cohort study for prediction of severity of AP, the incidence, risk factors, and outcomes of pancreatic hemorrhage were analyzed. Patients with significant hemorrhage were managed according to a predefined protocol including endovascular intervention. ResultsOut of 363 patients hospitalized during the study-period, 33(9%) patients developed hemorrhage. Median time from onset of AP to hemorrhage was 59(45–68) days. The cause of hemorrhage was arterial in 19(57.5%) patients and unlocalized in 14(42.5%) patients. Hemorrhage was managed by conservative approach in 7 (21.2%), radiographic angioembolisation in 16 (48.5%), radiographic angioembolisation followed by surgery in 3 (9.1%), and surgery in 7 (21.2%) patients. Persistent organ failure [aHR 2.3 (1.1–5.1), p = 0.03], use of large bore (>20 Fr) catheter for initial drainage [aHR 3.9 (1.7–9.1), p = 0.001] and extensive (>50%) necrosis [aHR 3.1 (1.4–6.9), p = 0.005] were significant risk factors for hemorrhage. Hemorrhage was an independent predictor of mortality [aHR 2.0 (1.2–3.4), p = 0.008] in addition to persistent organ failure (aHR 12.1 (5.7–25.8), p < 0.001). In-hospital mortality in patients with hemorrhage was 22/33 (66.7%) vs. 81/330 (25%) in no hemorrhage group [p <0.001]. ConclusionPancreatic hemorrhage occurs later in the course of acute pancreatitis in relatively sicker group of patients with organ failure and extensive necrosis, and is independently associated with a higher risk of in-hospital mortality.

The Anatomical Repair Technique to Correct Penile Hypospadias Provides Excellent Long-term Function with Low Complications

<i>Introduction</i> There are various techniques described for repair of penile hypospadias. <i>Objective</i> To present the anatomical repair technique and to discuss the lessons learned from this technique over 18 years. <i>Methods</i> All consecutive patients with penile hypospadias who underwent anatomical repair of urethra, spongiosum, bucks and dartos fascia and foreskin by the 3^rd author, with a minimum of 1 year follow up from January 2003 to March 2020 at the Royal Manchester Children's Hospital, United Kingdom, were included in the study. No formal ethics approval taken as this study was done as a service evaluation. Perioperative and follow up data were recorded prospectively in the departmental database. SIPP 21 was used for statistical analysis. Fisher’s Exact Test used for sub-group analysis. Findings were considered statistically significant at p<0.05. <i>Results</i> 368 patients had surgery at a median age of 18 months. 94.6% had no complications, 4.1% had minor and 1.3% had significant complications. 77.5% had a distal ectopic meatus. The mean length of urethroplasty was 8mm. To widen the urethral plate, a meatoplasty (M) was performed in 34% and urethral plate incision (UPI) in 14%. Catheters were used in 71% for a median duration of 7 days, and 40% had a 6F catheter. Regards to meatal stenosis the only statistically significant causative factor was UPI with 6fr catheter. P value=0.02. <i>Conclusions</i> Anatomical repair provides a completely normal penis with minimal complications. Meatoplasty widens the urethral-plate and reduces the risk for meatal stenosis.

Buddy Catheter Technique: A Method of Guiding the Mo.Ma Ultra into a Left Common Carotid Artery That Branches off the Aortic Arch at a Steep Angle.

The Mo.Ma Ultra is an embolic protection device used in carotid artery stenting (CAS). In cases of left internal carotid artery stenosis (ICS) in which the common carotid artery (CCA) branches off the aortic arch at a steep angle, insertion of the Mo.Ma Ultra into the CCA is sometimes difficult. We introduce a "buddy catheter technique" that helps guide the Mo.Ma Ultra into the CCA, with an additional 4 Fr catheter into the external carotid artery. An 84-year-old man with left ICS whose CCA also branched off the aortic arch at a steep angle also underwent CAS. The "buddy catheter technique" was used, and the Mo.Ma Ultra was inserted smoothly. The buddy catheter technique displaces the left CCA upward. Displacement straightens the vessels anatomically, and the ledge effect can be prevented by aligning the course of the vessels with the wire. Nevertheless, this technique requires bilateral femoral puncture, and so, complications can occur. The buddy catheter technique may be considered in cases in which the left CCA branches off the aortic arch at a steep angle.

On‐table urodynamic with ureteric occlusion: A resource for measuring bladder capacity and compliance in the management of patients with gross vesico‐ureteric reflux

To describe a technique for on-table urodynamic with ureteric occlusion (OUUO) and present a case series comparing bladder capacity and pressure measurements performed with and without ureteric occlusion in patients with gross vesico-ureteric reflux (grade ≥ IV VUR) to highlight the clinical utility. We performed OUUO in seven patients who were being considered for surgical management of VUR and/or nephro-ureterectomy. We occluded the refluxing ureters using hysterosalpingogram catheters (HSG, single lumen 5.5 Fr catheter with 1.5 ml balloon), guidewires, and rigid cystoscope. A 6 Fr dual-lumen urodynamic (UD) catheter is then inserted into the bladder to perform OUUO. Bladder capacity and Compliance (C = ∆bladder volume/∆detrusor pressure) are recorded and compared with values obtained at standard UD (without ureteric occlusion). The age range of the seven patients was 2.0-15.5 years. The etiology for the gross VUR were posterior urethral valve (PUV) and neuropathic. The bladder capacity and compliance finding between UD and OUUO findings were comparable in five patients. However, there was a clinically significant difference in bladder capacity (20%-50% decrease) and compliance (50%-90%) between UD and OUUO findings in two out of seven patients. In the presence of gross VUR, OUUO allows for a potentially more accurate assessment of bladder capacity and compliance. OUUO should be considered when planning ureteric opening bulking/reimplantation and nephro-ureterectomy.

A new invasive method to assess pulse wave velocity during cardiac catheterization

Abstract Pulse wave velocity (PWV) is an independent cardiovascular risk factor (CVRF), and there are multiple ways to measure it with more or less accuracy. We sought to easily develop an invasive gold standard axial PWV during cardiac catheterization between ascending aorta (AAo) and tibial artery (TIB) or humeral artery (HUM). Aorto-humeral PWV is not a usual measurement site because of its difficulty to estimate it non-invasively. Axial PWV demonstrates a greater correlation with CVRF, with carotid-femoral PWV the common way to estimate it non-invasively in hypertensive patients and others. Methods 26 patients were enrolled for AAo-TIB PWV measurements and 50 for AAo-HUM. A cuff connected to the hemodynamic Phillips workstation of the cathlab was placed around the right leg, at mid-calf, and was inflated to superimpose TIB pulsatile blood pressure waves on AAo blood pressure recorded with a fluid filled diagnostic 5 Fr or interventional 6 Fr catheter left at the end of the diagnostic coronary angiography in the ascending aorta. The distance between AAo and TIB was estimated by the distance between axillary and iliac crest, added with the distance between iliac crest and mid-calf. PWV was then calculated from the length estimated between AAo and mid-calf, and the time delay between AAo and TIB pulses (see figure) by gating to the R-wave of the ECG (upper trace) for both measurements, using a dedicated software written in MatLab®. For AAo=HUM PWV, in 50 patients the pressure of the catheter was sequencially recorded in the AoAsc then pulled back in the humeral artery. Both recordings were matched off-line based on the R top of the ECG recorded and the delay between the rise of the 2 pressure curves in the same MatLab® software. Results Mean age of our patients is 62,7±9,2 years. 82% had chronic hypertension and 33% had diabetes mellitus. 4 patients (15%) had clinical peripheral artery disease and only one had a stenting on femoral artery. No patients had previous vascular bypass. Aorto-tibial PWV showed an average PWV at 8.4±1.4 m/s. Aorto-humeral PWV showed an average PWV at 7.2±1.8 m/s. The PWV tended to be 0,6 m/s lower in patients with ≤2 cardiovascular risk factors versus &amp;gt;3. Conclusion We describe a simple and accurate PWV gold standard that can be recorded in any patient admitted for a coronary angiography. Aorto-tibial PWV is easier to obtain. Adding this parameter in the global assessment of patients with hypertension or other CVD will refine their CVRF profile. Funding Acknowledgement Type of funding sources: None.

PSI-2 A procedure for urine collection in pre-weaned heifer calves

Abstract Urine collection is a useful tool to analyze intestinal permeability in cattle for research and diagnostic purposes. However, urine sampling techniques often rely on total waste collection, which reduces the ability to perform more frequent sampling and obtain accurate and sterile urine volumes. A potential alternative is urethral catheters, which have been used in cows and weaned heifers. However, urethral catheters have not been thoroughly tested in pre-weaned dairy heifer calves. The study objective was to develop a urethral catheter placement procedure in pre-weaned heifer calves for continuous and accurate urine collection. Fifteen Holstein heifer calves had catheters placed at 8 ± 2 days (37.5 ± 3.38 kg BW) and 40 ± 2 days (59.3 ± 5.38 kg BW) of age. During the procedure, calves were individually housed (1.87 m2/calf) and restrained. The vulva was cleaned using betadine and 70% ethanol and then a sterile, lubricated 8.9 cm speculum was inserted into the vagina. A sterile guidewire (145 cm x 0.89 cm) was inserted into a lubricated sterile 10 FR catheter. The catheter was inserted into the urethral opening (~5–7 cm into vagina), guided into the bladder, and the catheter balloon was filled with water (10 mL). The guide wire was removed, and urine flow confirmed correct placement before a 4 L urinary drainage bag was attached to the catheter. Individual calf health observations were made twice over a 24-hour period and included vaginal discharge, bleeding, redness or inflammation, and tissue discharge in the urine. Occurrence rate was determined using PROC FREQ in SAS 9.4. Regardless of catheterization timing, bleeding and tissue discharge occurred at a rate of 3.33% ± 0.18, and vaginal discharge and inflammation occurred at a rate of 6.70% ± 0.25. In summary, this procedure is a viable method for total urine collection in pre-weaning heifer calves.

Enhanced Drainage Protocol in Large Amoebic Liver Abscess.

Background Amebic liver abscess (ALA) contributes significantly to morbidity and mortality in patients of the developing world. Even though medical management is the primary modality of treatment, 15% of the cases are refractory and require intervention for drainage. Pigtail catheterization is inefficient and results in a long duration of hospital stay. So, we conducted a prospective observational study to determine the efficacy and safety of drainage of large ALA using a wide bore 24 French (Fr) drain compared with a conventionally used 10 Fr pigtail catheter. Materials and Methods A single center prospective observational study was conducted over a period of 5 years and data of 122 patients was collected. After starting empirical medical therapy, patients underwent drainage of ALA with either a 10 French pigtail or a 24 Fr drain. The primary outcome variables were resolution of clinical symptoms such as fever and pain in abdomen, length of hospital stay, and resolution of abscess on imaging at day 3. Secondary outcome was complications related to the procedures. Results Data of 122 patients was collected. Males constituted a vast majority (96%) of the study population and the fifth decade was the most common age group involved. Alcoholics had a higher chance of developing a large ALA. Sixty-eight patients underwent drainage of the ALA using a 24 Fr drain which resulted in faster resolution of symptoms (2.4 vs. 5.1 days, p -value 0.033), a shorter duration of catheter in situ (6.4 vs. 13.2, p -value 0.011), and a faster drainage of ALA (residual volume at day 3; 177 vs. 212 mL, p -value 0.021). Twenty-eight patients had a biliary communication of which 26 required therapeutic endoscopic retrograde cholangiopancreatography. Conclusion In patients with a large ALA, placement of a wide bore 24 Fr catheter hastens recovery of the patients when compared with drainage with a standard 10 Fr pigtail catheter. Placement of a biliary stent serves as a useful adjunct for their management and it may obliviate the need for a major biliary diversion surgery.

811 WHETHER 10 WATER SWALLOWS NECESSARY TO OBTAIN REPRODUCIBLE RESULTS OF HIGH-RESOLUTION OESOPHAGEAL MANOMETRY?

Abstract Not less than ten wet swallows assessment in the primary test position is recommended by Chicago classification 4.0 for high-resolution oesophageal manometry (HREM); however, the required number of measurements are not sufficiently supported. Aim to evaluate the number of wet swallows necessary for correct interpretation of the results of lower esophageal sphincter integrated relaxation pressure (IRP) with low probability of type I and II errors. Methods Patients referred to perform HREM were enrolled. Solid-state 10Fr catheter and Solar (Laborie) software were used. Minimum 10 swallows by 5 mL water were obtained. These were analysed for cumulative means of IRP after 1…9 measurements. Conclusion made at each moment was compared with one based on 10 measurements. The results were characterized as true/false positive/negative for calculation of diagnostic accuracy. To exclude sample influence, Monte-Carlo simulation of sequential decision-making was performed with the use of sequential probability ratio test. Association of the diagnostic accuracy from recall was studied with the use of receiver operating characteristic curve (ROC) analysis. Results One hundred subjects were enrolled (25 with disorders of EGJ outflow). During the simulation, the probability of matching the decisions based on the 10 measurements and lower number of them was high. ROC analysis showed that actual probability to obtain false-positive results was twice as lower then ‘allowed’ rate of 5%. The probability to make false-negative results did not exceed 10% in any number of measurements. The probability that the conclusions made after 2 and after 10 measurements match was 0.9584 in those with disorders of EGJ outflow and 0.9652 in those without (figure 1). Conclusion The standard number of measurements required to support the presence of disorders of EGJ outflow during evaluation of 5 mL wet swallows in the primary position is excessive. Values of the IRP after 2 swallows allows to make similar decision to that after 10 swallows with &amp;gt;95% probability. This allows to reduce the number of wet swallows to assess in the primary position and save time for assessments in alternative position or perform provocation tests.

810 REPRODUCIBILITY OF REPEATED MEASUREMENTS OF OESOPHAGEAL MOTILITY METRICS WITHIN A STUDY

Abstract To compare reproducibility of repeated measurements of oesophageal motility metrics after 5 wet swallows within a study. Methods Patients referred for high-resolution esophageal manometry (HREM) to assess oesophageal motor function were enrolled. Solid-state 36-channel 10 Fr catheter (Unisensor AG) and Solar (MMS) software were used. Minimum 10 water swallows by 5 mL each were obtained. Two operators independently assessed the results of examination. Records of swallows were divided into 2 series by 5 measurements each. These series were compared by key metrics: integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), and contractile front velocity (CFV). Non-parametric statistics was used to compare the results. Results We enrolled 46 men and 68 women, age (mean ± SD) 48.8 ± 11.5 y.o. Of them, 52 patients had GERD, 25-different types of achalasia and 37 had no oesophageal disorders. The inter-observer agreement between 2 series of measurements reached 98%. No significant difference was found between the mean results of IRP, DCI, DL and CFV in 2 series of measurements (table 1). Conclusion No significant differences between studied HREM metrics in two series of measurements were found. The results of two series by 5 measurements within a study are reproducible. This may indicate the possibility of reducing the standard number of measurements. Reduction of time necessary for standard examination may allow additional time for functional tests (solid food swallows, RDC or MRS).