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Single 15-Min Protocol Yields the Same Cryoablation Size and Margin as the Conventional 10–8–10-Min Protocol: Results of Kidney and Liver Swine Experiment

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Abstract

Introduction

The objective was to determine the ablation size of a single 15-min freeze and compare it with the conventional 10-min freeze–8-min thaw–10-min freeze protocol. Secondary objectives were to determine the ablation margin and to ascertain whether islands of viable tissue remain within the ablation zone.

Materials and Methods

Five adult swine under general anesthesia were used. After surgical abdominal exposure, two ablations were performed in liver and two in kidney. One ablation utilized the 15-min and the second the 10–8–10-min protocol. At maximum ice-ball, tissue ink was infused via an angiographic catheter in hepatic or renal artery to stain the non-frozen tissue. Animals were euthanized and organs examined macro- and microscopically.

Results

Three histological regions were observed: (A) a viable/stained region representing the tissue outside the ice-ball, (B) a central necrotic area representing the ablated region within the ice-ball and (C) an unstained but viable margin representing the non-lethal margin within ice-ball. Ablation size did not vary with protocol but did for tissue type. Renal ablation was approximately 5 × 4 cm with both protocols, whereas liver ablation was approximately 6.7 × 4.4 cm. Ablation margin was measured at 1 mm irrespective of ablation protocol or tissue. No islands of viable tissue were identified within the ablation zone.

Discussion

Fifteen-minute cryoablation yielded an ablation size and margin identical to that of the conventional 10–8–10-min protocol. Within the ablated region, cell death was uniform. The only difference was a larger cryoablation zone in hepatic tissue compared to renal tissue, likely attributable to differences in blood perfusion.

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Funding

The study was supported by Galil Medical.

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Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, Department of Radiology, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA

    John D. Werner & Christos S. Georgiades

  2. Department of Pathology, The Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Aline C. Tregnago

  3. Department of Pathology, University of Alabama, 619 South 19th Street, Birmingham, AL, 35233, USA

    George J. Netto

  4. Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, 21205, USA

    Constantine Frangakis

Authors
  1. John D. Werner
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  2. Aline C. Tregnago
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  3. George J. Netto
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  4. Constantine Frangakis
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  5. Christos S. Georgiades
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Corresponding author

Correspondence to Christos S. Georgiades.

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Conflict of interest

Senior author is a consultant for Galil Medical. On behalf of the other authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

The study was approved by the Johns Hopkins University Animal Care & Use Committee.

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Werner, J.D., Tregnago, A.C., Netto, G.J. et al. Single 15-Min Protocol Yields the Same Cryoablation Size and Margin as the Conventional 10–8–10-Min Protocol: Results of Kidney and Liver Swine Experiment. Cardiovasc Intervent Radiol 41, 1089–1094 (2018). https://doi.org/10.1007/s00270-018-1950-z

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  • DOI: https://doi.org/10.1007/s00270-018-1950-z

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