The safety of electrolytically induced hepatic necrosis in a pig model.
BACKGROUND
Electrolysis fulfils the criteria for an ideal treatment of patients with unresectable liver tumours. Previous studies in the rat and pig have shown that controlled necrosis can be safely produced by inserting platinum electrodes into normal liver' parenchyma and liver tumours. As with any new treatment it is mandatory to investigate the 'worst-case scenario' of inadvertent intravascular electrode placement in a large animal model before progressing to clinical trials.


METHODS
Under ultrasound control in six pigs, electrodes were inserted into, or immediately adjacent to, an hepatic vein. An electrolytic 'dose' of 100 C was then administered and the evolution of the lesion was monitored using ultrasound. Venous blood was collected before and during the electrolysis to evaluate potential acid/base disturbances and animals were closely monitored during electrolysis and during their recovery until a full autopsy was performed 4-7 days after treatment.


RESULTS
Gas bubbles were seen to enter the hepatic veins or interior vena cava during treatment in five of the six animals. There were no major complications as a consequence and all animals recovered and remained in a healthy state until they were killed. At autopsy one animal had complete thrombotic occlusion of the left hepatic vein. Otherwise, findings were normal.


CONCLUSIONS
In the clinical setting, due to the use of ultrasound to guide electrode placement into the centre of a tumour, the electrodes should rarely juxtapose an hepatic vein. Nevertheless, in this extreme situation, electrolysis is surprisingly safe with only one major vascular occlusion and no morbidity or mortality.
Wemyss-Holden
S A
SA
University of Adelaide Department of Surgery, Queen Elizabeth Hospital, Woodville, South Australia.
de la M Hall
P
P
Robertson
G S
GS
Dennison
A R
AR
Vanderzon
P S
PS
Maddern
G J
GJ
D000818:Animals; D004195:Disease Models, Animal; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D004572:Electrolysis; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008113:Liver Neoplasms / Q000628:therapy*; D008991:Monitoring, Physiologic; D009336:Necrosis; D051381:Rats; D012449:Safety; D013552:Swine; D018084:Ultrasonography, Interventional