title: Experimental computed tomography-guided vena cava puncture in pigs for percutaneous brachytherapy of middle mediastinal lymph node metastases.
abstract: BACKGROUND
  Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model (group of 12 pigs) to assess the safety and feasibility of computed tomography (CT)-guided vena cava puncture.
  
  
  METHODS
  Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava (AVC) in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair.
  
  
  RESULTS
  Following postoperative enhanced CT, two animals were found to have a small pneumothorax (one being hemopneumothorax). The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer.
  
  
  CONCLUSIONS
  CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.
authors.forename: Min
authors.initials: M
authors.lastname: Zhao
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.forename: Sheng-Yong
authors.initials: SY
authors.lastname: Li
authors.forename: Yong-Zheng
authors.initials: YZ
authors.lastname: Wang
authors.affiliation: Department of Interventional Medicine, The Second Hospital of Shandong University, Shandong 250033, China.
authors.forename: Yu-Liang
authors.initials: YL
authors.lastname: Li
authors.forename: Yancu
authors.initials: Y
authors.lastname: Hertzanu
mesh_terms: D000818:Animals; D001918:Brachytherapy / Q000379:methods*; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D013552:Swine; D014057:Tomography, X-Ray Computed