Endovascular Catheters for Interventionalists

ANGIOGRAPHIC CATHETERS: A COMPREHENSIVE REVIEW FOR THE INTERVENTIONALIST IN-TRAINING Department of Interventional Radiology, Kaiser Permanente, Los Angeles, CA
R Freed; A Urdaneta; R Darflinger; G Vatakencherry
SUPRA-AORTIC
CATHETER NOMENCLATURE
Vascular Catheters
Diagnostic Catheters
Guide Catheters
Vascular catheters are categorized as diagnostic or
Diagnostic catheter sizes range from 4F to 6F, and
guide. Diagnostic catheters are further categorized into lengths from 50 to 125 cm, respectively. Many catheters
selective and flush. Both diagnostic and guide catheters are braided, with a soft tip.
have a variety of head shapes to choose from. The
name of the shape is consistent among both types of
catheters, although there are generally less guide
catheter shapes to choose from. Trackability
Guide catheters are generally 6F, 7F or 8F and range
from 65 to 100 cm in length. Guide catheters have
reinforced construction and a much stiffer shaft to
provide back-up support for the advancement of
guidewires, balloons and stents. Pushability
The ability of the catheter to follow the guidewire
through tortuous vessels and around corners without
pulling the wire out of it intended location.
H1
H3
Headhunter 1
Headhunter 3
H1H
!
HY1
CBL
Headhunter
Yadav!
!!
Modified
Headhunter
HN3
HN4
Newton III
Cerebral
Burke!
VERT
Newton IV
Vertebral!
Torquability
The description of how a force applied by the operator
at the hub of the catheter relates to the forward
movement of the tip (the leading edge) of the catheter.
The steering responsiveness of the catheter tip to
handling maneuvers performed at the hub.
SIM 1
SIM 2
Simmons I
SIM 3
Simmons II
JB 1
Simmons III
JB 2
Bentson I
DAV
Bentson II
KMP
Davis
TEGT
Kumpe
BERN
Teg-T
Berenstein
BER 2
Berenstein II
JB 3
MAN
CK1
VTK
WNBG
Bentson III
Mani
CK1
Vitek
Weinberg
!
!
CARDIAC
Flush Straight
Simple Curve
Complex Curve
Reverse Curve
Double Curve
Catheter head shape determines function. Catheter head shapes can be categorized as simple and complex. Simple curves have a single primary
curve. Complex curves have a primary and secondary curve, and sometimes more. Two types of complex curves include the reverse curve and the
double curve. The flush catheter typically round to protect the vessel walls from the whipping effect during power-injected boluses of contrast.
CATHETER CONSTRUCTION
Surface Coat
Surface coatings can modify
thrombogenicity, friction
coefficient or antimicrobial
properties.
Internal Internal Mammary Judkins Mammary
Left 3.5
Victor Behar
Outer Layer
o  Polyurethane catheters are softer and more pliable and
follow guidewires more easily, but have a higher
coefficient of friction.
o  Nylon catheters, which are stiffer and tolerate higher flow
rates, are useful for aortography and general
arteriography.
o  Teflon is the stiffest material and is used mainly for
dilators and sheaths.
Tip
A rounded tip is considered to
be less traumatic than square
cut tubing or bevel ended
tubing which is easier to insert.
Right Coronary
Bypass
Reinforcement
Many catheters have single or double wire-braiding for
extra torquability. Highly braided catheters, while having
excellent torque control, tend to be “all or nothing” in their
response. !
Judkins Left 4.0
Left Coronary Amplatz
Left 1
Bypass
Left Internal
Mammary 1
Amplatz
Left 2
Judkins Right 3.5
Judkins Right 4.0
Amplatz
Left 3
Amplatz
Right 1
Left Internal
Mammary 2
Sones 1
Amplatz Right Amplatz
Right 2
1 Modified
Saphenous Vein
Graft Right
Saphenous Vein
Graft Left
AORTA
CATHETER SELECTION
Sones 3
Sones 2
PULMONARY
C
A
E
B
D
CATHETER SELECTION – Select a catheter that points in the general direction you wish to travel. For example, if you want to cross the aortic
bifurcation, you need at least the curvature of a cobra catheter.
A)  TIP LENGTH – Increased length offers more stability in target vessel at the cost of maneuverability in the parent vessel.
B)  PRIMARY CURVE – Choose the optimal curve by assessing the angle of the target vessel from its parent artery. C)  SECONDARY CURVE – Choose the optimal curve by assessing the width of the parent vessel.
D)  TERTIARY CURVE – Choose the optimal curve by assessing normal curvature of the parent vessel.
E)  CATHETER LENGTH – o Shorter length catheters (50 cm) are used for the contralateral iliac artery injections. o Mid length catheters (65 cm) are used for the visceral vessel cannulation (renal, celiac, superior mesenteric). o Longer length catheters (100-125 cm) are used for the abdominal arch and its branches. PIG
TR
STR
UNIV
Pigtail
Tennis Racket
Straight
Universal Flush
Omni Flush
!!
APC
GPC
Van Aman
Grollman
BRONCHIAL, SPINAL
MIK
RENAL
CHG2.5 CHG-B CHG-C CHG-E
Mickaelson Chung
2.5
Chung
B
Chung
C
Chung
E
C1
C2
C3
Cobra I
Cobra II
RDC 1
RDC Cobra III ! Renal Double
Curve Small!
Omni Sos
Renal Double
Curve!
VISCERAL
CATHETER HANDLING
VS
VS 1
Visceral
Visceral 1
VS 2
Visceral 2!
SHK 0.8
SHK 1.0
Shepard Hook 0.8!
Shepard
Hook 1.0!
RC 1
RC 2
J Curve I
J Curve II
Omni
Sos
Rosch Uni Select II!
RIM
USL 2
Inferior
Mesenteric!
The aorta spin technique for reforming
a complex curve catheter.
Simultaneous spinning and pushing.
MPA 1
MPA
Multipurpose A
Normal Curve!
MPB
MPC
MPD
Multipurpose C
Multipurpose A Multipurpose B
Large Curve!
Small Curve!
Multipurpose D
LEV 1
HS Levin 1
Hockey Stick!
UTERINE
The Waltman Loop technique.
To get up and over the aortic
bifurcation.
To form a complex curve catheter in the left subclavian artery.
TC-BNK
Tight Curve
Binkert
To form a figure-of-eight or reverse curve to cannulate the
right carotid.
To position a simple curve end-hole catheter in the
innominate artery.
UP & OVER
To form a loop in a complex curve
catheter off the aortic valve.
TC
RUC
Tight Curve! Roberts Uterine
Catheter!
CONTRA I
CONTRA II
J
Contralateral I
Contralateral II
J Curve
REFERENCES
1. OSBORN, A. DIAGNOSTIC CEREBRAL ANGIOGRAPHY. 1999, 2ND EDITION. PHILADEPHIA, PA: LIPPINCOTT WILLIAMS & WILKINS.
2. SCHNEIDER, P. ENDOVASCULAR SKILLS. 2009, 3RD EDITION. NEW YORK, NY: INFORMA HEALTHCARE.
✔
3. KAUFMAN, J. VASCULAR & INTERVENTIONAL RADIOLOGY, THE REQUISITES. 2004, 1ST EDITION. PHILADELPHIA, PA: ELSEVIER.
4. CORDIS PRODUCT CATALOG.
5. COOK PRODUCT CATALOG.
6. MERIT PRODUCT CATALOG.
!