Hepatic Angiography: A Procedure to Visualize Liver Tumor Vessels in a Rabbit Model

Overview

In this video, we demonstrate a step-by-step procedure to perform hepatic angiography using a fluoroscope that enables the real-time visualization of blood vessels associated with a liver tumor in a rabbit model.

Protocol

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Angiographic Utilization of the VX2 Liver Tumor

1. Anesthetize the rabbit using 45 mg/kg ketamine and 5 mg/kg xylazine for induction followed by intubation and maintenance with 1%-3% isoflurane as needed. When the rabbit is anesthetized, shave the surgical site using hair clippers. Clean the incision area using a triplicate wash with betadine scrub, 70% ethanol solution, and betadine solution, and drape the groin area in a sterile surgical fashion.
2. Palpate the femoral groove in the groin. When the groove has been identified, make a 2-3 cm linear incision along the groove (Figure 1).
3. Using blunt dissection, locate and isolate the femoral bundle containing the femoral vein, artery, and nerve (Figure 2).
4. Again, use blunt dissection to separate the femoral artery from the rest of the structures in the bundle and isolate the artery atop a scalpel handle (Figure 3).
5. With a 3-French introducer kit, utilize the Seldinger technique to gain access with a needle. Insert a guidewire and remove the needle to advance the 3-French sheath into the vessel (Figure 4).
   CAUTION: Avoid using excessive force in advancing the 3-French sheath, as this can result in transection of the femoral artery.
6. Under fluoroscopic guidance and using a catheter, guidewire, and iohexol contrast agent, select for the celiac trunk — typically located at the T12 level — and then advance the catheter into the left hepatic artery via the common hepatic and proper hepatic.
7. At this point, administer the agent of choice through the catheter. Once the agent is administered, remove the catheter.
8. Using 3-0 silk suture, ligate the femoral artery proximally and distally to the insertion point of the sheath. Be sure to tighten the knot proximal to the sheath as it is withdrawn to prevent bleeding.
9. Close the groin incision with 4-0 polyglactin 910 sutures on a cutting needle using a subcuticular stitch.
10. Maintain standard post-operative care and monitor animal recovery. Perform euthanasia and necropsy as needed using standard techniques.

Representative Results

Figure 1: The femoral groove and initial incision. (A) Palpation of the hind limb allows for visualization of the femoral groove (white dotted line). (B) Initial incision in the hind limb made along the femoral groove.

Figure 2: Identification of the femoral bundle. Blunt dissection of the initial incision reveals femoral vein (black arrow).

Figure 3: Dissection of femoral bundle and isolation of femoral artery. (A) Dissection of the femoral bundle allows us to individually distinguish (from left to right) the femoral vein (FV), femoral artery (FA), and femoral nerve (FN). (B) The femoral artery isolated on a scalpel handle. Note the blood column allowing for distinction from the femoral nerve. 

Figure 4: Vascular access. (A) A guidewire (G) is advanced into the femoral artery (FA) through the access needle (N) which was previously inserted into the femoral artery. (B) A sheath (S) and dilator (D) are advanced over the guidewire (G) into the femoral artery (FA). (C) Sheath (S) and dilator are advanced fully into the femoral artery (FA) up to the sheath hub. (D) Sheath is secured with silk after the dilator and guidewire have been removed. Aspiration yields blood (black arrow) in the sheath. 

Materials

Name	Company	Catalog Number	Comments
Hair Clippers	Wahl	41870-0438
Ketamine	Henry Schein	56344
Xylazine	Akorn	59399-110-20
15-Blade	Steris	02-050-015
11-Blade	Steris	02-050-011
Scalpel Handle x 2	Steris	22-2381
3-0 PDS / Taper	Ethicon	Z305H
4 - 0 Vicryl / Cutting	Ethicon	J392H
3-F VSI Micro-HV Introducer Kit	Vascular Solutions	Custom Order (P15180391)
.018 45° angle glidewire	Terumo	RG*GA1818SA
Direxion bern-shape microcatheter	Boston Scientific	M001195230
Omnipaque	GE	Y510