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
coefficientor 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

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
oShorter length catheters (50 cm) are used for the contralateral iliac artery injections.
oMid length catheters (65 cm) are used for the visceral vessel cannulation (renal, celiac, superior mesenteric).
oLonger 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

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.