Abstract
Cryoablation refers to all methods of destroying tissue by freezing [ 1 ]. Cryoablation can be performed via surgical (open or laparoscopic) or percutaneous approaches. Percutaneous cryoablation begins with the insertion of a specialized needle (cryoprobe) into malignant tissue under imaging guidance; the needle is then rapidlycooled to subzero temperatures, causing removal of heat from the tissue via conduction. Rapid extracellular cooling results in the formation of extracellular ice crystals, which sequesters free water, increasing the tonicity of the extracellular space. Osmotic tension draws free intracellular water from cells, resulting in dehydration [ 2 ]. The concomitant increase in intracellular solute concentration results in damage to cytoplasmic enzymes and the destabilization of the cell membrane. Rapid intracellular cooling results in intracellular ice crystal formation, a harbinger of lethal cellular injury and subsequent cell [ 3 ]. Although the exact mechanism of cellular damage from intracellular ice formation is unknown, injury is thought to be mediated by physical damage to intracellular membranes of organelles and the plasma membrane. During thawing, melting ice within the extracellular space results in its hypotonicity with respect to the intracellular compartment. This osmotic gradient can trigger a fl uid shift, leading to cell swelling and/or bursting. In addition, an in flux of free water into the intracellular space provides substrate for the growth of intracellular ice crystals, exacerbating their biocidal effects Cellular injury is maximized by optimizing four factors: increasing cooling rate, lowering target temperature, increasing time at target temperature, and decreasing thawing rate [ 5 ] (Fig. 3.1 ).
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol. 2009;20(7 Suppl):S377–90.
Mazur P. Freezing of living cells: mechanisms and implications. Am J Physiol. 1984;247(3 Pt 1):C125–42.
Bryant G. DSC measurement of cell suspensions during successive freezing runs: implications for the mechanisms of intracellular ice formation. Cryobiology. 1995;32(2):114–28.
Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37(3):171–86.
Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int. 2005;95(9):1187–91.
O’Rourke AP, Haemmerich D, Prakash P, Converse MC, Mahvi DM, Webster JG. Current status of liver tumor ablation devices. Expert Rev Med Devices. 2007;4(4):523–37.
Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PF. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure. Radiology. 1999;212(3):673–81.
Tacke J, Speetzen R, Heschel I, Hunter DW, Rau G, Günther RW. Imaging of interstitial cryotherapy – an in vitro comparison of ultrasound, computed tomography, and magnetic resonance imaging. Cryobiology. 1999;38(3):250–9.
Tuncali K, Morrison PR, Tatli S, Silverman SG. MRI-guided percutaneous cryoablation of renal tumors: use of external manual displacement of adjacent bowel loops. Eur J Radiol. 2006;59(2):198–202.
Evonich 3rd RF, Nori DM, Haines DE. A randomized trial comparing effects of radiofrequency and cryoablation on the structural integrity of esophageal tissue. J Interv Card Electrophysiol. 2007;19(2):77–83.
Ablin RJ, Soanes WA, Gonder MJ. Elution of in vivo bound antiprostatic epithelial antibodies following multiple cryotherapy of carcinoma of prostate. Urology. 1973;2(3):276–9.
den Brok MH, Sutmuller RP, Nierkens S, et al. Efficient loading of dendritic cells following cryo and radiofrequency ablation in combination with immune modulation induces anti-tumour immunity. Br J Cancer. 2006;95(7):896–905.
Chapman WC, Debelak JP, Blackwell TS, et al. Hepatic cryoablation-induced acute lung injury: pulmonary hemodynamic and permeability effects in a sheep model. Arch Surg. 2000;135(6):667–72; discussion 72–3.
Washington K, Debelak JP, Gobbell C, et al. Hepatic cryoablation-induced acute lung injury: histopathologic findings. J Surg Res. 2001;95(1):1–7.
Seifert JK, Stewart GJ, Hewitt PM, Bolton EJ, Junginger T, Morris DL. Interleukin-6 and tumor necrosis factor-alpha levels following hepatic cryotherapy: association with volume and duration of freezing. World J Surg. 1999;23(10):1019–26.
Hruby G, Edelstein A, Karpf J, et al. Risk factors associated with renal parenchymal fracture during laparoscopic cryoablation. BJU Int. 2008;102(6):723–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
Erinjeri, J.P. (2013). Overview of Thermal Ablation Devices: Cryoablation. In: Clark, T., Sabharwal, T. (eds) Interventional Radiology Techniques in Ablation. Techniques in Interventional Radiology. Springer, London. https://doi.org/10.1007/978-0-85729-094-6_3
Download citation
DOI: https://doi.org/10.1007/978-0-85729-094-6_3
Published:
Publisher Name: Springer, London
Print ISBN: 978-0-85729-093-9
Online ISBN: 978-0-85729-094-6
eBook Packages: MedicineMedicine (R0)