In vivo comparison of simultaneous versus sequential injection technique for thermochemical ablation in a porcine model.

PURPOSE: To investigate simultaneous and sequential injection thermochemical ablation in a porcine model, and compare them to sham and acid-only ablation. MATERIALS AND METHODS: This IACUC-approved study involved 11 pigs in an acute setting. Ultrasound was used to guide placement of a thermocouple probe and coaxial device designed for thermochemical ablation. Solutions of 10 M acetic acid and NaOH were used in the study. Four injections per pig were performed in identical order at a total rate of 4 mL/min: saline sham, simultaneous, sequential, and acid only. Volume and sphericity of zones of coagulation were measured. Fixed specimens were examined by H&E stain. RESULTS: Average coagulation volumes were 11.2 mL (simultaneous), 19.0 mL (sequential) and 4.4 mL (acid). The highest temperature, 81.3°C, was obtained with simultaneous injection. Average temperatures were 61.1°C (simultaneous), 47.7°C (sequential) and 39.5°C (acid only). Sphericity coefficients (0.83-0.89) had no statistically significant difference among conditions. CONCLUSIONS: Thermochemical ablation produced substantial volumes of coagulated tissues relative to the amounts of reagents injected, considerably greater than acid alone in either technique employed. The largest volumes were obtained with sequential injection, yet this came at a price in one case of cardiac arrest. Simultaneous injection yielded the highest recorded temperatures and may be tolerated as well as or better than acid injection alone. Although this pilot study did not show a clear advantage for either sequential or simultaneous methods, the results indicate that thermochemical ablation is attractive for further investigation with regard to both safety and efficacy.

In vitro thermal profile suitability assessment of acids and bases for thermochemical ablation: underlying principles.

PURPOSE: To measure and compare temperature changes in a recently developed gel phantom for thermochemical ablation as a function of reagent strength and concentration with several acids and bases. MATERIALS AND METHODS: Aliquots (0.5-1 mL) of hydrochloric acid or acetic acid and sodium hydroxide or aqueous ammonia were injected for 5 seconds into a hydrophobic gel phantom. Stepwise increments in concentration were used to survey the temperature changes caused by these reactions. Injections were performed in triplicate, measured with a thermocouple probe, and plotted as functions of concentration and time. RESULTS: Maximum temperatures were reached almost immediately in all cases, reaching 75 degrees C-110 degrees C at the higher concentrations. The highest temperatures were seen with hydrochloric acid and either base. More concentrated solutions of sodium hydroxide tended to mix incompletely, such that experiments at 9 M and higher were difficult to perform consistently. CONCLUSIONS: Higher concentrations for any reagent resulted in higher temperatures. Stronger acid and base combinations resulted in higher temperatures versus weak acid and base combinations at the same concentration. Maximum temperatures obtained are in a range known to cause tissue coagulation, and all combinations tested therefore appeared suitable for further investigation in thermochemical ablation. Because of the loss of the reaction chamber shape at higher concentrations of stronger agents, the phantom does not allow complete characterization under these circumstances. Adequate mixing of reagents to maximize heating potential and avoid systemic exposure to unreacted acid and base must be addressed if the method is to be safely employed in tissues. In addition, understanding factors that control lesion shape in a more realistic tissue model will be critical.

A hydrophobic gel phantom for study of thermochemical ablation: initial results using a weak acid and weak base.

PURPOSE: To develop a model for study of exothermic chemical reactions potentially useful for tissue ablation. MATERIALS AND METHODS: Seven gelatins ranging from 0.5% to 30% wt/vol with and without 15% or 30% caps and several commercial gels were evaluated. Baseline temperature measurements were taken. Acetic acid and ammonium hydroxide were sequentially injected over periods of 10-15 seconds in 1-mL aliquots, forming a discrete aqueous reaction chamber. Congo red pH indicator was included to assess the reaction. A thermocouple allowed data collection at completion of injection and every 15 seconds for 5 minutes. Injections were performed in triplicate, and average temperatures for each time point were reported. RESULTS: Gelatins fractured or refluxed even at the lowest concentrations tested. Most commercial gels proved too viscous and likewise led to reflux along the needle tract. A mineral oil-based gel was selected because of its ability to form a chamber without reflux or fracture and its clear colorless character, hydrophobic nature, chemical stability, viscosity, specific gravity, and cost. Temperatures during the first 60 seconds of the neutralization reaction showed an immediate increase that correlated well with concentration. CONCLUSIONS: The oil gel phantom is a safe, useful, readily available, inexpensive model to study mixing behaviors and maximum heating potentials for reactions that may prove useful in thermochemical tissue ablation for oncologic interventions. Measurable temperature changes occurred even at the lowest concentrations, and higher concentrations produced a greater release of heat energy.