Selective access catheters are designed for catheterization and subselection of vessel ostia, biliary, urogenital, or digestive tracts. They come in different tip shapes that have wall-seeking behavior. They also ensure the advancement down the target destination and provide positional stability during subsequent opacification and manipulation.
Properties
They come in different materials, tip-shape, lengths, number and size of side holes, pressure rates, volume rates, and radiopacity.
Size and length
French-size: 4 to 6 F.
Lengths: from 40 to 125 cm.
Side holes
Most selective catheters have a single end hole1.
Stiffness
They have a rotational stiffness that allows accurate manipulation transmission from the hub to the tip.
Pressure and volume rates
Single-end hole catheters require low flow rates compared to flush catheters since side holes reduce the end-hole jet effect2.
Hydrophilic coating
They can be hydrophilic or non-hydrophilic.
Hydrophilic coating allows smooth gliding through vessels, but reduces stability and rotational stiffness.
Catheter curves
-
primary curve - the closest to the tip
must approximate the takeoff angle of the target ostium to allow for the selection and maintenance of the tip within the vessel
-
secondary curve
should approximate the form of the main trunk vessel - tortuosity should be taken into account3
allows the advancement of the catheter into the target vessel.
-
tertiary curve - behind the secondary curve
maintains a firm catheter position by opposing the back vascular wall of the target ostium (e.g. Mikaelsson catheter)
turns a floppy tip in midstream into a stable device ready to engage the target ostium
this curve creates a vascular contact that redirects the vertical pushing force towards the desired ostium axis.
Tip shapes
The main factors that influence the choice of tip shape are:
diameter of the trunk vessel
angle of the target vessel ostium
The shape and length of the tip should be adapted to the ostium to avoid catheter dislodgment after vessel selection.
Cerebral selective catheters
Bentson 1, 2, 3
Bentson-hanafee-wilson (JB 1, 2, 3)
Newton (HN3, HN4)
Osborne 1, 2
Simmons / Sidewinder / SOS Omni
Left internal mammary artery access catheters
LIMA
modified LIMA
judkins right
Bronchial artery access catheters
-
femoral route
The upper limb route (e.g. radial, brachial) is not adapted for bronchial artery access.
Right coronary artery access catheters4
Judkins right - JR
Judkins curve right - JCR
femoral right - FR
amplatz right - AR
Left coronary artery access catheters4
Judkins left - JL
Judkins curve left - JCL
femoral left - FL
amplatz left - AL
Celiac artery access catheters
-
radial route
-
femoral route
Rosch Celiac (RCI, RC2, RC3)
renal double-curve (RDC)
Renal artery access catheters
-
radial route
MPA
-
femoral route
renal double-curve (RDC)
Renal vein access catheters
-
upper limb vein (basilic or brachial) approach
-
femoral route
Superior mesenteric artery access catheters
-
radial route
-
femoral route
Inferior mesenteric artery access catheters
-
femoral route
Lumbar artery access catheters
-
femoral route
The upper limb route (e.g. radial, brachial) is not adapted for lumbar artery access.
Others
Bile ducts / urinary access catheter
Kumpe - KMP
Angled selective catheter
Multipurpose (MPA, MPA 2, MPB)
SH MPA
Hockey stick 1, 2
Precautions
To decrease the risk of vascular injury:
catheters should always be inserted and withdrawn over wires, as the tip of catheters moving within a vessel can cause dissection
always verify the catheter's pressure rate limit while using the power injector since surpassing these thresholds can damage both the catheter and the blood vessel.
Catheters with side holes are not suited for embolization as this increased the risk of non-target vessel embolization.
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