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 catheters are generally 6F, 7F or 8F and range
guide. Diagnostic catheters are further categorized into lengths from 50 to 125 cm, respectively. Many catheters from 65 to 100 cm in length. Guide catheters have
selective and flush. Both diagnostic and guide catheters are braided, with a soft tip. reinforced construction and a much stiffer shaft to
have a variety of head shapes to choose from. The provide back-up support for the advancement of
name of the shape is consistent among both types of guidewires, balloons and stents. H1 H3 H1H HY1 CBL HN3 HN4 VERT
Headhunter 1 Headhunter 3 ! Modified Headhunter Cerebral Newton III Newton IV Vertebral!
catheters, although there are generally less guide Headhunter Yadav!
!! Burke!
catheter shapes to choose from.

Trackability Pushability Torquability
The ability of the catheter to follow the guidewire The description of how a force applied by the operator The steering responsiveness of the catheter tip to
through tortuous vessels and around corners without at the hub of the catheter relates to the forward handling maneuvers performed at the hub.
pulling the wire out of it intended location. movement of the tip (the leading edge) of the catheter.
SIM 1 SIM 2 SIM 3 DAV KMP TEGT BERN BER 2
Simmons I Simmons II Simmons III Davis Kumpe Teg-T Berenstein Berenstein II !

JB 1 JB 2 JB 3 MAN CK1 VTK WNBG

Bentson I Bentson II 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 Internal Internal Mammary Judkins

Mammary Left 3.5
Judkins
Left 4.0
Judkins
Right 3.5
Judkins
Right 4.0
Sones 1 Sones 2 Sones 3
Victor Behar

Surface Coat Outer Layer

Surface coatings can modify o  Polyurethane catheters are softer and more pliable and
thrombogenicity, friction follow guidewires more easily, but have a higher
coefficient or antimicrobial coefficient of friction.
properties. o  Nylon catheters, which are stiffer and tolerate higher flow
rates, are useful for aortography and general
arteriography. Right Coronary Left Coronary Amplatz Amplatz Amplatz Amplatz Amplatz Right Amplatz
o  Teflon is the stiffest material and is used mainly for Bypass Bypass Left 1 Left 2 Left 3 Right 1 1 Modified Right 2
Tip dilators and sheaths.
A rounded tip is considered to
be less traumatic than square
Reinforcement
cut tubing or bevel ended
Many catheters have single or double wire-braiding for
tubing which is easier to insert.
extra torquability. Highly braided catheters, while having
excellent torque control, tend to be “all or nothing” in their
response.
Left Internal Left Internal Saphenous Vein Saphenous Vein
! Mammary 1 Mammary 2 Graft Left Graft Right

AORTA PULMONARY
CATHETER SELECTION
C

CATHETER SELECTION – PIG TR STR UNIV

Select a catheter that points in the general direction you wish to travel. For example, if you want to cross the aortic Pigtail Tennis Racket Straight Universal Flush !! APC GPC
A bifurcation, you need at least the curvature of a cobra catheter. Omni Flush Van Aman Grollman

A)  TIP LENGTH – Increased length offers more stability in target vessel at the cost of maneuverability in the parent vessel.
BRONCHIAL, SPINAL RENAL
B)  PRIMARY CURVE – Choose the optimal curve by assessing the angle of the target vessel from its parent artery.
E B 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 –
D 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.
C1 C2 C3 RDC 1 RDC Omni Sos
MIK CHG2.5 CHG-B CHG-C CHG-E
Cobra I Cobra II Cobra III ! Renal Double Renal Double
Mickaelson Chung Chung Chung Chung Curve Small! Curve!
2.5 B C E

VISCERAL
CATHETER HANDLING

VS VS 1 VS 2 SHK 0.8 SHK 1.0 RC 1 RC 2 RIM USL 2 Omni

Sos
Visceral Visceral 1 Visceral 2! Shepard Shepard J Curve I J Curve II Rosch Uni Select II!
Hook 0.8! Hook 1.0! Inferior
Mesenteric!
The aorta spin technique for reforming
a complex curve catheter.
Simultaneous spinning and pushing.

MPA 1 MPA MPB MPC MPD LEV 1 HS

Multipurpose A Multipurpose A Multipurpose B Multipurpose C Multipurpose D Levin 1 Hockey Stick!
Normal Curve! Small Curve! Large Curve!

UTERINE UP & OVER

To get up and over the aortic To form a complex curve catheter in the left subclavian artery.
The Waltman Loop technique.
bifurcation.

TC-BNK TC RUC CONTRA I CONTRA II J

Tight Curve Tight Curve! Roberts Uterine Contralateral I Contralateral II J Curve !
Binkert Catheter!

REFERENCES
To form a figure-of-eight or reverse curve to cannulate the To position a simple curve end-hole catheter in the To form a loop in a complex curve 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.
right carotid. innominate artery. catheter off the aortic valve. ✔
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.