This article describes a method for visualizing tumor-associated liver blood vessels using a rabbit model. The technique involves catheterization and the injection of contrast dye to enhance imaging during fluoroscopy.
To visualize the tumor-associated liver blood vessels, place an anesthetized rabbit model of a hepatic tumor in a supine position on an operating table. Sterilize the groin area and make an incision to expose the femoral bundle. Place an instrument handle under the femoral bundle and separate the femoral artery from the adjoining vein and nerve.
Puncture the femoral artery with a Seldinger needle and advance it into the vessel. Next, insert the guidewire through the needle into the artery and then remove the needle. Pass a sheath over the guidewire, and advance it into the artery. Finally, insert an angiographic catheter and inject a small volume of contrast dye into the blood vessel.
The contrast dye contains iodine, a substance that X-rays cannot pass through, making the blood vessel visible as a dark, shadowy structure against a bright background. This enables the real-time visualization of the catheter movement through the femoral artery on a fluoroscope.
Continue advancing the catheter until it reaches the liver blood vessels. When the catheter tip reaches the artery close to the tumor site, inject a suitable volume of the contrast agent. As the contrast dye circulates, it makes the blood vessels visible on the angiogram, revealing the vasculature associated with the tumor.
Palpate the femoral groove in the groin, and make a 2 to 3-centimeter linear incision along the groove. Using blunt dissection, locate and isolate the femoral bundle containing the femoral vein, artery, and nerve, and use blunt dissection to separate the femoral artery from the rest of the structures in the bundle. Isolate the artery atop a scalpel handle, and use the Seldinger technique and a 3-French introducer kit, to introduce a needle into the vessel.
Insert a guidewire into the artery, and remove the needle, to carefully advance the 3-French sheath into the vessel. Remove the dilator and guidewire from the sheath to complete vascular access. Under fluoroscopic guidance, insert the catheter into the celiac trunk at the T12 level, and advance the catheter into the left hepatic artery via the common hepatic and proper hepatic arteries.
When the catheter reaches the left hepatic artery, inject contrast agent to confirm the presence of a hypervascular tumor, which can then be treated with an intra-arterial therapy of choice, and remove the catheter. Using 3-0 silk suture, ligate the femoral artery proximally and distally to the insertion point of the sheath, taking care to tighten the knot proximal to the sheath as it is withdrawn to prevent bleeding. Then, use 4-0 polyglactin 910 sutures on a cutting needle and a subcuticular stitch to close the groin incision.
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