Percutaneous Transcholecystic Biliary Interventions Using Gallbladder Anchors: Feasibility Study in the Swine Jorge E. Lopera, 1 David Kirsch, 1 Zhong Qian, 1 Bernardo Ruiz, 2 Augusto Brazzini, 1 Arturo Gonzales, 1 Wilfrido Castaneda-Zuniga 1 1 Department of Radiology, Louisiana State University, 1542 Tulane Avenue, New Orleans, LA 70112, USA 2 Department of Pathology, Louisiana State University, 1542 Tulane Avenue, New Orleans, LA 70112, USA Abstract The purpose of this study was to report our initial experi- encewithaswinemodelforbiliaryinterventionsbyusinga percutaneous transcholecystic access after suture anchor of the gallbladder. Telepaque tablets were given to five pigs to opacify the gallbladder. Under fluoroscopy, the opacified gallbladder was punctured percutaneously and three suture anchors were used to fix the anterior wall of the gallbladder totheabdominalwall.Twoweekslater,thegallbladderwas punctured and access into the distal common bile was ob- tained through the cystic duct. Balloon expandable stents were deployed into the distal common bile duct. Follow-up cholangiograms were obtained at 1 and 2 weeks. Necropsy was performed after 2 weeks to evaluate the relationship between the gallbladder and abdominal wall. Suture anchor placement was successful in all five pigs. One pig with a deep and highly positioned gallbladder developed fever, anorexia,andvomitingsecondarytoexcessivestretchofthe gallbladder. Placement of the guidewire through the ex- tremely tortuous and small cystic ducts proved to be the mostchallengingstepoftheprocedure.Metallicstentswere successfully deployed in all four pigs in which it was at- tempted. Four animals tolerated the procedures without changes in their clinical conditions and no symptoms. Successful follow-up cholangiograms were performed at 1 and 2 weeks post-stent deployment without complications. All stents remained patent during the follow-up period. Necropsy demonstrated close attachment and adherence of the gallbladders to the antero-lateral abdominal wall in all four animals. Suture anchoring of the gallbladder is feasible in most pigs with superficially located gallbladders. This technique allows a safe and repeat access into the biliary system using a transcholecystic approach. Key words: Biliary interventions—Animal model Percutaneous interventional procedures are an integral part of the minimally invasive treatment of benign and malig- nant diseases of the biliary tract [1, 2]. The swine model has been frequently used for preclinical evaluation of bil- iary interventional procedures and devices due to its sim- ilarity to the human system [3]. The gallbladder in the swine is superficially located and easily accessed, and, unlike the canine model, it is not enveloped by the liver parenchyma [4]. Difficulties associated with percutaneous access due to gallbladder mobility in the swine model, however, have made dilatation of the tract and exchange of catheters nearly impossible [4]. Previous models have re- quired either an open surgery for anchoring the gallbladder followed by placement of large bore external tubes or the initial percutaneous insertion of a permanent catheter to be left exiting the abdomen until a mature tract is formed [2, 5–8]. We describe the use of suture anchors to attach the gallbladder to the anterolateral abdominal wall in order to facilitate a safe and effective percutaneous access to the gallbladder for subsequent biliary interventions. Materials and Methods Fivepigs,weighing25.7–54.5kg,wereeachgiven3gofiopanoic acid (Telepaque; Amersham, Princeton, NJ) orally the day prior to theprocedure,inordertoopacifythegallbladder,andfastedfor24 h. Anesthesia for each procedure consisted of Telazol/Xylazine (4.4–1 mg/kg i.m.) and endotracheal intubation. The study was approved by the Institutional Animal Care and Use Committee at our institution. Correspondence to: Jorge E. Lopera; email: jloper@lsuhsc.edu ª Springer Science+Business Media, Inc. 2005 Published Online: 30 June 2005 CardioVascular and Interventional Radiology Cardiovasc Intervent Radiol (2005) 28:467–471 DOI: 10.1007/s00270-004-9215-4