Sidewinder catheter

Catheter Cobra I/sidewinder I or II 4-5 60-100 > Optional Distal part... 

Catheters 1.5-F appropriate femorovisceral glide-catheter e.g. Cobra 2 or Sidewinder 1 or 2 2. Coaxial catheters are often very useful if superselective or distal embolization is necessary 1.5-F Sos type catheter or Waltman loop often usefiil in large diameter aortas 2. Multipurpose or Beren-stein catheters useful if arm approach 4-F femorovisceral catheters are less torquable than 5-F... 

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. 

Most studies have reported using a femoral vein approach. The left spermatic vein requires a double curve catheter to reach the ISV origin, and the right ISV is best entered with a sidewinder type catheter. Because of the double curve required to get into either spermatic vein, the femoral technique frequently requires coaxial catheters or a catheter exchange to reach an appropriate level in the ISV. 

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...

The celiac trunk and hepatic artery are usually catheterized by 4-F or 5-F catheters (cobra or sidewinder configuration), while the tumor-bearing target vessels should be approached by 2.7- to 3-F coaxial micro-catheters. The advantages of a microcatheter system are the increased injection resistance, which reduces the risk of microsphere reflux, and the smaller likelihood of vascular spasms. 

Diagnostic procedures are performed with 4 to 5 French diagnostic catheters single (Berenstein) or double curve (Sidewinder) depending on the tortuosity of the vessels. These catheters are used in combination with guidewires (0.035 ) (Fig. 18.6). 

Fig. 18.6. Diagnostic catheters with simple (Berenstein), double curve (Sidewinder) and guide wire with curved tip...

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