Shepherd hook catheter

The Shepherd hook catheter is a common reverse-curve selective access catheter designed for catheterisation and subselection of visceral arteries, in order to secure access, advance, and exchange devices, or deliver contrast in the target vessel.

It is particularly adapted for the catheterisation of lumbar and bronchial arteries through the femoral approach.

Properties

• size: 4 Fr or 5 Fr

• recommended guidewire

  • 0.035″ (0.89 mm) for both 4 and 5 Fr

• length: 65 cm

• ports (side holes): two side holes in general

• proximal end: Luer lock hub

• distal tip: may be tapered, there is generally no bumper-tip

• maximum flow injection rate

  • these rates vary according to the manufacturer and should be verified in the catheter package

  • 20 mL/s

  • 1065 psi or 75 kg/cm²

• shapes - The shepherd catheter comes in different shapes:

  • Shepherd Hook 0.8

  • Shepherd Hook 1.0

  • Shepherd Hook 1.0 1modified

Intructions for vascular access

• secure peripheral vascular access with a sheath catheter

• flush the shephed hook catheter and the navigation guidewire (glidewire)

• insert the glidewire in the shephed catheter and then place the assembly in the sheath catheter

• advance the the glidewire until reaching the desired region for formation of the catheter

Formation of the Shepherd

Similarly to all reverse-curve selective access catheter (e.g. the Simmons catheter), the shepherd hook can be used in closed and open-loop configuration.

It's formation is rather is easy and the most common method in the arterial system is the aortic arch method.

After the formation

• advance the closed-loop shepherd hook catheter until reaching the target ostium using as reference

  • 3D volume rendering CT images

  • bony lmandmarks

• advance and retract the catheter until the target ostium is catheretrised

• perform an angiogram to confirm the target vessel

• advance the glidewire in the target vessel and then secure the open-loop Shepherd hook catheter by advancing it on the wire

Indications

• coeliac or superior mesenteric artery aceess - femoral route

  • TACE/TAE

  • radioembolisation

  • haemostatic embolisation

  • splenic artery embolisation

  • gastric ischaemic conditioning

• lumbar artery access - femoral route

  • haemostatic embolisation

  • transarterial embolisation

• bronchial artery access - femoral route

  • haemostatic embolisation

Precautions

• catheters should always be inserted and withdrawn over wires, as the tip of catheters moving within a vessel can cause dissection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 pressure rate limit while using the power injector since surpassing these thresholds can damage both the catheter and the blood vessel

• in case of resistance while advancing or withdrawing the catheter, it is important to stop and identify the underlying cause of the resistance before proceeding further

• avoid bending or kinking the catheter before its placement, as doing so may damage the catheter and lead to injury for the patient

• in a setting of catheter exchange, to avoid sheath catheter thrombus migration, an aspiration through the sheath catheter should be performed before insertion of the new catheter