title: Significance of total vascular exclusion for hepatic cryotherapy: an experimental study.
abstract: BACKGROUND
  In the liver, efficacy of cryosurgical ablation of tumors located near the retrohepatic vena cava is impaired by the heat-sink effect. This could be overcome by total vascular exclusion (TVE) of the liver. In this study, the effect of TVE on cryosurgical ablation of liver tissue close to the retrohepatic vena cava was investigated with regard to the extent of the cryolesion and complications arising from necrosis of the caval wall.
  
  
  METHODS
  Of a total of 28 pigs, 14 underwent cryotherapy with TVE compared to 14 without TVE, both involving the vena cava. 7 animals in each group were subjected to one freeze cycle and 7 in each group to two freeze cycles. Temperatures in the cryolesion were monitored and cryolesions were documented sonographically. Laboratory parameters were determined pre- and postoperatively. Follow-up was 14 days. Morphology, extent of the cryolesion, damage to the vena cava and complications were assessed after autopsy.
  
  
  RESULTS
  With TVE, freezing rates were increased and cryolesions were significantly larger than without TVE. Transmural necroses of the vena cava with complete necrosis of the intima occurred significantly more frequently after TVE. Macro- and microscopically, the damage to the caval wall was considerably more marked after cryotherapy under TVE but in all cases the continuity of the vessel wall remained intact. There were no ruptures, thrombosis, or strictures of the vena cava.
  
  
  CONCLUSIONS
  The combination of cryotherapy and TVE increases the effectiveness of cryoablation in the liver involving the retrohepatic vena cava without any severe vascular complications occurring in the pig.
authors.affiliation: Department of General Surgery, University of Freiburg, Freiburg, Germany. jungrait@chir.ukl.uni-freiburg.de
authors.forename: W
authors.initials: W
authors.lastname: Jungraithmayr
authors.forename: M
authors.initials: M
authors.lastname: Szarzynski
authors.forename: H
authors.initials: H
authors.lastname: Neeff
authors.forename: J
authors.initials: J
authors.lastname: Haberstroh
authors.forename: G
authors.initials: G
authors.lastname: Kirste
authors.forename: A
authors.initials: A
authors.lastname: Schmitt-Graeff
authors.forename: E H
authors.initials: EH
authors.lastname: Farthmann
authors.forename: S
authors.initials: S
authors.lastname: Eggstein
mesh_terms: D000818:Animals; D003250:Constriction; D017679:Cryotherapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D006439:Hemodynamics; D007432:Intraoperative Period; D008099:Liver / Q000473:pathology / Q000601:surgery*; D008102:Liver Circulation; D013552:Swine; D013696:Temperature; D014463:Ultrasonography; D014684:Venae Cavae / Q000000981:diagnostic imaging / Q000473:pathology