Cobra catheter

Fig. 5.1. DSA of celiac trunk with a 5-F Cobra catheter. Left gastric artery (white arrow), splenic artery (arrowheads), common hepatic artery (white arrowhead), gastroduodenal artery (small white arrow), right gastroepiploic artery (small white arrowheads), left (small arrow) and right (double small arrow) hepatic artery...

Fig. 5.2. DSA of the hepatic artery with a 5-F Cobra catheter. Gastroduodenal artery (white arrow/zeads),rightgastroepiploic artery (black arrowheads), right gastric artery (white arrow) branching from the left hepatic artery, arcade (white arrows) connecting right and left gastric artery (black arrows)...

Fig. 5.3. DSA with a 5-F Cobra catheter of an inferior esophageal artery (arrow) showing anastomoses with cardiac branches (arrowheads) of the left gastric artery (arrows)...

Catheterization of bilateral uterine arteries is mandatory. A cobra-shaped catheter is the best catheter to use for easy insertion into uterine arteries. The cobra catheter is available in three different types, each according to the degree of opening of the curve. The medium sized catheter (C2) is the one most commonly used. When using a 4-F catheter, one should make sure that the lumen of the catheter is able to accept 0.038-in. guidewire for possible microcatheter use. The contralateral internal iliac artery is catheterized first and can be reached by pushing the cobra. In some difficult cases, a curved catheter, such as SOS or sidewinder, could be handy to cross the aortic bifurcation. 

A catheter, usually a Cobra catheter is introduced into the right femoral vein and directed into the peripheral left renal vein. Selective ovarian venog-... 

For femoral approach 5-F Cobra catheter for left ovarian vein... 

Fig. 7.1. Dilated and tortuous ureter being negotiated with a cobra catheter over and guidewire...

Anatomic Consideration The internal iliac arteries, the blood supply to the viscera of the true pelvis, are readily approached after femoral arterial access. The ipsilateral internal iliac artery is usually catheterized with a reverse curve catheter configuration and the contralateral internal iliac artery is usually accessed following passage over the aortic bifurcation with a forward seeking cobra catheter. On rare occasions because of atherosclerotic stenosis or occlusion of one femoral artery, two catheters (4-5 F) can be... 

Technical Considerations Contralateral puncture of each femoral artery and catheterization of each branch of the vascular supply to the neoplasm can be accomplished with an exaggerated cobra catheter configuration. Ipsilateral puncture and catheterization is possible by forming a long reverse curve or sidewinder (Simmons) configuration. 

Fig. 2.5.1. Photograph shows catheters frequently used for chemoembolization, including pigtail, sidewinder, and cobra catheter...

Proximal Embolization In the absence of active contrast extravasation, the splenic artery is proximally embolized. We typically utilize either a 5F Cobra catheter or a 5F Omni-2 catheter to catheterize the celiac axis. Depending on the tortuosity of the vessel, we then either use the Cobra catheter or a microcatheter with a 0.021 inner luminal diameter for more selective catheterization. Once the catheter is in place, just distal to the dorsal pancreatic artery, coils are deposited. The size of the coils chosen depends on the size of the vessel. 

Bentson or hydrophilic wire to gain peripheral access using a 5 F Cobra catheter (can be 4 F hydrophilic)... 

Typically, the celiac axis is selected with either a Sos or Cobra catheter from the groin and nonselec-... 

Typically a groin approach is used and the celiac axis is selected with a Sos catheter. Selective angiography is performed to lay out the splenic artery. A glidewire is then passed distally and either the Sos or a Cobra catheter is advanced. Embolization can be performed through the 5 French catheter at this point. If too tortuous, then a microcatheter can be passed coaxially. (Fig. 8.4) We use either a Mass Transit (Cordis, Miami, FL) or Renegade (Boston Scientific, Boston, MA) microcatheter. These catheters can withstand a power injection of 2-3 cc per second if needed. 

Irrespective of the type of varicocele, the sclerotherapy procedure is the same. Our technical protocol for percutaneous endovascular occlusion of the ISV is as follows IV sedation by Ketamine/ Midazolam, femoral vein approach, 7-F Cobra catheter with coaxial 3-F or Tracker 18 for distal sclerotherapy by sodium tetradecyl sulfate (STS) followed by more proximal coil occlusion, bed-rest for 4 hours, and discharge 6 hours post-procedure (Fig. 23.13a,b). Results are assessed by the referring surgeon 2 months later. 

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