Simmons catheter

Last revised by Yahya Baba on 11 Oct 2023

The Simmons catheter, also known as Sidewinder 1, Sim, or SS catheter, is a common reverse-curve angiographic selective access catheter designed for catheterization and subselection of brachiocephalic or visceral arteries, in order to secure access, advance, and exchange devices, or deliver contrast in the target vessel. It was first designed to approach tortuous and elongated aortic arch vessels 2.

  • size: 4 Fr or 5 Fr

  • recommended guidewire

    • 0.035″ (0.89 mm) for 4 Fr

    • 0.038″ (0.97 mm) for 5 Fr

  • length: 65-100 cm

  • ports (side holes): end-hole catheter, no side holes

  • 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

    • 15 mL/s

    • 814 psi or 57 kg/cm²

It is a reverse-curve shaped catheter with:

  • primary curve: has a vertical oblique takeoff angle

  • reversed secondary curve also known as the knee: this curve allows catheter advancement by pulling rather than pushing, leading to easier and faster catheter placement

  • tertiary curve: helps in the anchorage at the aorta

The sim catheter comes in different types:

  • Sim 1: smallest diameter and a curve shape to facilitate maneuverability and access in small vessels

  • Sim 2: larger curve compared to Sim 1 and is used for procedures that require access to larger and longer blood vessels

    • indicated for type III aortic arch vessels

  • Sim 3: larger than Sim 2

  • Sim 4: has a different shape than the other simmmons

  • secure peripheral vascular access with a sheath catheter

  • flush the Sim catheter and the navigation guidewire (glidewire)

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

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

Although the Sim catheter is designed to be used in a closed-loop formation, it can be used in an open loop configuration.

There are various methods described for its formation in the arterial system, such as the:

In the venous system, the formation can be performed using

  • advance the closed-loop sim catheter until reaching the target ostium, using as reference

    • 3D volume rendering CT images

    • bony landmarks

  • advance glidewire in the Sim catheter to partially open the loop

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

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

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 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

This catheter was first described in 1973 by Charles R. Simmons 4.

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