Initial experience with a new quantitative assessment tool for                     fluorescent imaging in peripheral artery disease

Abstract. Background: Perioperative evaluation in peripheral artery disease (PAD) by common vascular diagnostic tools is limited by open wounds, medial calcinosis or an altered collateral supply of the foot. Indocyanine green fluorescent imaging (ICG-FI) has recently been introduced as an alternative tool, but so far a standardized quantitative assessment of tissue perfusion in vascular surgery has not been performed for this purpose. The aim of this feasibility study was to investigate a new software for quantitative assessment of tissue perfusion in patients with PAD using indocyanine green fluorescent imaging (ICG-FI) before and after peripheral bypass grafting. Patients and methods: Indocyanine green fluorescent imaging was performed in seven patients using the SPY Elite system before and after peripheral bypass grafting for PAD (Rutherford III-VI). Visual and quantitative evaluation of tissue perfusion was assessed in an area of low perfusion (ALP) and high perfusion (AHP), each by three independent investigators. Data assessment was performed offline using a specially customized software package (Institute for Laser Technology, University Ulm, GmbH). Slope of fluorescent intensity (SFI) was measured as time-intensity curves. Values were compared to ankle-brachial index (ABI), slope of oscillation (SOO), and time to peak (TTP) obtained from photoplethysmography (PPG). Results: All measurements before and after surgery were successfully performed, showing that ABI, TTP, and SOO increased significantly compared to preoperative values, all being statistically significant (P < 0.05), except for TTP (p = 0.061). Further, SFI increased significantly in both ALP and AHP (P < 0.05) and correlated considerably with ABI, TTP, and SOO (P < 0.05). Conclusions: In addition to ABI and slope of oscillation (SOO), the ICG-FI technique allows visual assessment in combination with quantitative assessment of tissue perfusion in patients with PAD. Ratios related to different perfusion patterns and SFI seem to be useful tools to reduce factors disturbing ICG-FI measurements.

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Initial Experience with a New Quantitative Assessment Tool for Fluorescent Imaging In Peripheral Artery Disease

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.768 ◽

2019 ◽

Vol 58 (6) ◽

pp. e199-e200

Author(s):

Henrik Rieß ◽

Anna Duprée ◽

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Eike Sebastian Debus ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Quantitative Assessment ◽

Assessment Tool ◽

Fluorescent Imaging ◽

Initial Experience ◽

Peripheral Artery ◽

Artery Disease

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Validation of quantitative assessment of indocyanine green fluorescent imaging in a one-vessel model

PLoS ONE ◽

10.1371/journal.pone.0240188 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0240188

Author(s):

Anna Duprée ◽

Henrik C. Rieß ◽

Philipp H. von Kroge ◽

Jakob R. Izbicki ◽

Eike S. Debus ◽

...

Keyword(s):

Blood Flow ◽

Indocyanine Green ◽

Gastric Tube ◽

Flow Measurement ◽

Quantitative Assessment ◽

Tissue Perfusion ◽

Fluorescent Imaging ◽

Gastroepiploic Artery ◽

Time Flow ◽

The Right

Objectives Evaluation of intestinal perfusion remains subjective and depends on the surgeon´s individual experience. Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) fluorescence using a near-infrared camera system has been described in different ways and for different indications. The aim of the present study was to evaluate fluorescent imaging (FI) in the quantitative assessment of intestinal perfusion in a gastric tube model in pigs and to compare the results to results obtained with florescent microspheres (FM), the gold standard for tissue perfusion. Methods Seven pigs (56.0±3.0 kg), both males and females, underwent gastric tube formation after transection and ligation of the gastric arteries, except the right gastroepiploic artery, to avoid collateral blood flow. After baseline assessment (T0), hypotension (T1) was induced by propofol (Karampinis et al 2017) (< 60 mmHg). Then, propofol was paused to obtain normotension (T2, Mean arterial pressure (MAP) 60–90 mmHg). Finally, hypertension (T3, MAP>90 mmHg) was induced by norepinephrine. Measurements were performed in three regions of interest (ROIs) under standardized conditions: the fundus (D1), corpus (D2), and prepyloric area (D3). Hemodynamic parameters and transit-time flow measurement (TTFM) in the right gastroepiploic artery were continuously assessed. FI, FM and the partial pressure of tissue oxygen (TpO2) were quantified in each ROI. Results The study protocol could successfully be performed during stable hemodynamics. Flow in the gastroepiploic artery measured by transit time flow measurement (TTFM) was related to hemodynamic changes between the measurements, indicating improved blood flow with increasing MAP. The distal part of the gastric tube (D1) showed significantly (p<0.05) impaired perfusion compared to the proximal parts D3 and D2 using FM. ICG-FI also showed the highest values in D3 and the lowest values in D1 at all hemodynamic levels (T1-T3; p<0,05). Conclusion Visual and quantitative assessment of gastric tube perfusion is feasible in an experimental setting using ICG-FI. This might be a promising tool for intraoperative assessment during visceral surgery in the future.

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Discrete plasmapheres method possibilities in improving peripheral microcirculation in patients with atherosclerosis of the arteries of low extremities

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2015-14-4-18-21 ◽

2015 ◽

Vol 14 (4) ◽

pp. 18-21

Author(s):

Y. S. Andozhskaya ◽

A. N. Galileyeva

Keyword(s):

Clinical Status ◽

Spectral Characteristics ◽

Suggested Method ◽

Peripheral Artery ◽

Doppler Flow ◽

Before And After ◽

Peripheral Microcirculation ◽

Flow Changes ◽

Artery Disease

Introduction and aim. In this study discrete plasmapheres method possibilities in the treatment of the patients with III stage of peripheral artery disease were investigated. The aim of current investigation was to find out the changes of the peripheral microcirculation. Materials and methods: microcirculation was investigated with Minimax-Doppler Ê device before and after treatment of 48 patients with intermittent claudication. Results and discussion. It was found that peripheral microcirculation data and spectral characteristics of Doppler flow changes and clinical status of the patients eventually improved after treatment by suggested method. In conclusion, treatment by suggested method of discrete plasmapheres is effective on one of the most complicated group of patients with III stage of ischemia according to Fontaine-Pokrovsky classification of atherosclerosis of the arteries of low extremities.

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Hemostatic changes in patients with peripheral artery disease before and after bypass surgery

Khirurgiya Zhurnal im N I Pirogova ◽

10.17116/hirurgia2018846 ◽

2018 ◽

pp. 46

Author(s):

R. E. Kalinin ◽

I. A. Suchkov ◽

N. D. Mzhavanadze ◽

V. G. Demikhov ◽

O. N. Zhurina ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Bypass Surgery ◽

Peripheral Artery ◽

Before And After ◽

Artery Disease

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Real-time identification of liver cancers by using indocyanine green fluorescent imaging

Cancer ◽

10.1002/cncr.24291 ◽

2009 ◽

Vol 115 (11) ◽

pp. 2491-2504 ◽

Cited By ~ 365

Author(s):

Takeaki Ishizawa ◽

Noriyoshi Fukushima ◽

Junji Shibahara ◽

Koichi Masuda ◽

Sumihito Tamura ◽

...

Keyword(s):

Indocyanine Green ◽

Real Time ◽

Fluorescent Imaging ◽

Liver Cancers ◽

Real Time Identification ◽

Green Fluorescent

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Detection of Bile Leakage After Hepatic Resection by Intraoperative Indocyanine Green Fluorescent Imaging

Fluorescence Imaging for Surgeons ◽

10.1007/978-3-319-15678-1_18 ◽

2015 ◽

pp. 177-183

Author(s):

Masaki Kaibori ◽

Kosuke Matsui ◽

Morihiko Ishizaki ◽

Masanori Kon

Keyword(s):

Indocyanine Green ◽

Hepatic Resection ◽

Bile Leakage ◽

Fluorescent Imaging ◽

Green Fluorescent

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Clinicopathological study of surgery for pulmonary metastases of hepatoblastoma with indocyanine green fluorescent imaging

10.22541/au.161280281.13803796/v1 ◽

2021 ◽

Author(s):

Misa Yoshida ◽

Mio Tanaka ◽

Norihiko Kitagawa ◽

Masato Shinkai ◽

Hiroaki Goto ◽

...

Keyword(s):

Indocyanine Green ◽

Pulmonary Metastases ◽

False Negative ◽

Clinical Information ◽

High Sensitivity ◽

Fluorescent Imaging ◽

Metastatic Lesions ◽

Pulmonary Metastasectomies ◽

Lung Metastasectomy ◽

Green Fluorescent

Background: The prognosis of metastatic hepatoblastoma remains poor; to improve it, pulmonary metastasis must be controlled. Indocyanine green (ICG) fluorescent imaging has been used recently for lung metastasectomy. The objective of our study was to clarify the usefulness of ICG imaging for lung metastasectomy of hepatoblastoma using detailed clinicopathological analysis. Procedure: Patients with hepatoblastoma who underwent resection of pulmonary metastases with ICG fluorescent imaging were studied using retrospective analysis of clinical information, a review of their surgical records, and a histological analysis of their metastatic nodules. Results: Sixteen patients were enrolled. In total, 61 ICG-imaging-guided pulmonary metastasectomies were performed, and 350 ICG-positive and 23 ICG-negative specimens were identified. Tumors were confirmed in 250 of the ICG-positive specimens, including eight nonpalpable nodules, on microscopic examination. One hundred ICG-positive specimens and histologically tumor-negative specimens showed histological changes suggesting the regression of a tumor or bloodstream disturbance. The palpable ICG-negative tumors showed more-severe atypia than the ICG-positive tumors. Conclusions: This study demonstrates the high sensitivity of ICG imaging in detecting metastatic lesions of hepatoblastoma. Histological examinations suggested that ICG imaging detects not only tumor cells, but also nontumorous pulmonary tissues affected by bloodstream disturbance. Because a number of false-positive specimens were detected, further optimization of the dose of ICG and the timing of its administration may be required for thorough metastasectomy. Several false-negative specimens were also detected, suggesting the presence of ICG-negative metastatic tumors. Palpation during operation and imaging studies remain essential for detecting metastatic lesions, even in the era of ICG imaging.

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