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.
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Properties
size: 4 Fr or 5 Fr
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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
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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
Curves
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
Shapes
The sim catheter comes in different types:
Sim 1: smallest diameter and a curve shape to facilitate maneuverability and access in small vessels
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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
Intructions for vascular access
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
Formation of the Simmons
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:
left subclavian method: considered the best and safest 3
In the venous system, the formation can be performed using
the common iliac veins method
the hepatic vein method
After the formation
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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
Indications
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neurointerventions through transradial or transfemoral approach
endovascular clot retrieval / thrombectomy
carotid stenting
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renal vein procedures through upper arm peripheral vein
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celiac or superior mesenteric artery procedures through femoral access
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 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
History and etymology
This catheter was first described in 1973 by Charles R. Simmons 4.
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