162 IMPACT OF FLOW SPEED OF ICG FLUORESCENCE IN THE GASTRIC CONDUIT AND THORACIC INLET SPACE ON ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
K Koyanagi ◽  
S Ozawa ◽  
Y Ninomiya ◽  
K Yatabe ◽  
T Higuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Anastomotic Leakage ◽  
Fluorescence Imaging ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Thoracic Inlet ◽  
Speed Reduction ◽  
Clinicopathological Findings ◽  
Conduit Wall ◽  
The Impact

Abstract   We have previously demonstrated that the flow speed of indocyanine green (ICG) fluorescence in the gastric conduit wall could predict anastomotic leakage after esophagectomy. Surround organs via retrosternal route is considered to affect the blood flow in the gastric conduit and anastomotic leakage. In the study, we investigated the impact of the flow speed of ICG fluorescence in the gastric conduit wall and thoracic inlet space on anastomotic leakage after esophagectomy. Methods A total of 142 patients, who underwent esophagectomy with three-field lymph node dissection, simultaneous reconstruction using a gastric conduit, and cervical anastomosis via retrosternal route, were prospectively investigated. Using ICG fluorescence imaging, blood flow speed of the gastric conduit wall was assessed before and after anastomosis (pre speed and post speed (cm/s)) and correlated with clinicopathological findings. Parameters of thoracic inlet space was assessed using CT scan and correlated with blood flow speed of the gastric conduit wall and anastomotic leakage. Results Median pre speed was 2.54 (0.73–6.10) cm/s and median post speed was dropped by 1.77 (0.32–8.67) cm/s. Speed reduction (pre speed—post speed) and speed reduction rate ((pre speed—post speed)/pre speed) were negatively correlated with thoracic inlet area (TIA) (P = 0.004, P = 0.021). Pre speed and post speed of the patients with anastomotic leakage were significantly slower than those of the patients without anastomotic leakage, respectively (P < 0.001 and P = 0.050). In 115 patients with pre speed more than 1.98 cm/s, TIA was significantly associated with anastomotic leakage after esophagectomy (P < 0.001). Conclusion We clearly demonstrated that retrosternal route reduced the blood flow of the gastric conduit wall using ICG fluorescence imaging. Narrow thoracic inlet space might obstruct the blood flow of the gastric conduit wall and cause anastomotic leakage after esophagectomy.

649 EFFECTS OF THE PREPARATION METHOD ON THE ICG FLUORESCENCE BLOOD FLOW IN THE GASTRIC CONDUIT AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazuo Koyanagi ◽  
Soji Ozawa ◽  
Yamato Ninomiya ◽  
Kentaro Yatabe ◽  
Tadashi Higuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Fluorescence Imaging ◽  
Conventional Method ◽  
Current Method ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Gastric Artery ◽  
Conduit Wall ◽  
Lesser Curvature

Abstract   In this study, we investigated how the blood flow of gastric conduit changed due to the difference in the lesser curvature cut line using ICG fluorescence imaging in patients with esophageal cancer. Methods A total of 193 cases of esophageal cancer surgery with gastric conduit reconstruction were included. (Conventional method) The lesser curvature cut line of the stomach was started from a distance of 5 cm from the pylorus (141 cases). (Current method) Gastric lesser curvature dissection was started from the last branch of the left gastric artery (52 cases). Blood flow of the gastric conduit was measured by the ICG fluorescence imaging, and the correlation between the changes in the gastric conduit and both blood flow and anastomotic failure was examined. Results Median length of the lesser curvature cut line was 10 cm from the pylorus in the current method, which was significantly longer than that in the conventional method (P < 0.001). Congestion at the tip of the gastric conduit were more observed in the conventional method (P = 0.02). The ICG fluorescent blood flow speed in the gastric conduit wall was 2.54 cm/s by the conventional method and 2.82 cm/s by the current method (P = 0.03). There were 23 cases (16.3%) of anastomotic leakage in the conventional method and 4 cases (7.7%) in the current method (P = 0.09). Conclusion By preserving the right gastric artery and vein, improvement of venous return is expected, and it is suggested that blood flow in the gastric conduit wall can be well maintained.

scholarly journals Anastomotic leakage after esophagectomy possibly caused by compression of the gastric conduit behind the sternoclavicular joint: a report of three cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasunori Kurahashi ◽  
Yudai Hojo ◽  
Tatsuro Nakamura ◽  
Tsutomu Kumamoto ◽  
Yoshinori Ishida ◽  
...  
Keyword(s):  
Blood Flow ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Wall ◽  
Sternoclavicular Joint ◽  
Gastric Conduit ◽  
Thoracic Inlet ◽  
Indocyanine Green Fluorescence ◽  
Subtotal Esophagectomy ◽  
First Case

Abstract Background The narrowness of the thoracic inlet is often a problem in retrosternal reconstruction after esophagectomy. We report here three cases in which compression of the gastric conduit behind the sternoclavicular joint possibly caused anastomotic leakage. Case presentations The first case was a 71-year-old man who underwent subtotal esophagectomy for upper esophageal cancer followed by retrosternal reconstruction. On postoperative day 2, he developed septic shock and underwent reoperation because of a necrotic gastric conduit. The tip of the conduit above the manubrium was necrotic due to strangulation as a result of compression by the sternoclavicular joint. The second and third cases were a 50-year-old woman and a 71-year-old man who underwent subtotal esophagectomy for middle and lower esophageal cancer, respectively, followed by retrosternal reconstruction. Despite indocyanine green fluorescence imaging indicating adequate blood flow in both cases, the tip of the conduit appeared pale and congested because of compression by the sternoclavicular joint after anastomosis. Postoperatively, these two patients developed anastomotic leakage that was confirmed endoscopically on the ventral side of the gastric wall that had been pale intraoperatively. Conclusions When performing reconstruction using the retrosternal route after esophagectomy, it is important to ensure that compression by the sternoclavicular joint does not have an adverse impact on blood flow at the tip of the gastric conduit.

scholarly journals Occlusion of Cortical Ascending Venules Causes Blood Flow Decreases, Reversals in Flow Direction, and Vessel Dilation in Upstream Capillaries

2011 ◽  
Vol 31 (11) ◽  
pp. 2243-2254 ◽  
Author(s):  
John Nguyen ◽  
Nozomi Nishimura ◽  
Robert N Fetcho ◽  
Costantino Iadecola ◽  
Chris B Schaffer
Keyword(s):  
Blood Flow ◽  
Nearest Neighbor ◽  
Flow Direction ◽  
Cognitive Disorders ◽  
Laser Pulses ◽  
Vessel Diameter ◽  
Flow Speed ◽  
Femtosecond Laser Pulses ◽  
Brain Diseases ◽  
The Impact

The accumulation of small strokes has been linked to cognitive dysfunction. Although most animal models have focused on the impact of arteriole occlusions, clinical evidence indicates that venule occlusions may also be important. We used two-photon excited fluorescence microscopy to quantify changes in blood flow and vessel diameter in capillaries after occlusion of single ascending or surface cortical venules as a function of the connectivity between the measured capillary and the occluded venule. Clotting was induced by injuring the target vessel wall with femtosecond laser pulses. After an ascending venule (AV) occlusion, upstream capillaries showed decreases in blood flow speed, high rates of reversal in flow direction, and increases in vessel diameter. Surface venule occlusions produced similar effects, unless a collateral venule provided a new drain. Finally, we showed that AVs and penetrating arterioles have different nearest-neighbor spacing but capillaries branching from them have similar topology, which together predicted the severity and spatial extent of blood flow reduction after occlusion of either one. These results provide detailed insights into the widespread hemodynamic changes produced by cortical venule occlusions and may help elucidate the role of venule occlusions in the development of cognitive disorders and other brain diseases.

scholarly journals Blood flow speed of the gastric conduit assessed by indocyanine green fluorescence

Medicine ◽  
2016 ◽  
Vol 95 (30) ◽  
pp. e4386 ◽  
Author(s):  
Kazuo Koyanagi ◽  
Soji Ozawa ◽  
Junya Oguma ◽  
Akihito Kazuno ◽  
Yasushi Yamazaki ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Flow Speed ◽  
Gastric Conduit ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence

scholarly journals Novel Intraoperative Imaging of Gastric Tube Perfusion during Oncologic Esophagectomy—A Pilot Study Comparing Hyperspectral Imaging (HSI) and Fluorescence Imaging (FI) with Indocyanine Green (ICG)

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 97
Author(s):  
Sebastian Hennig ◽  
Boris Jansen-Winkeln ◽  
Hannes Köhler ◽  
Luise Knospe ◽  
Claire Chalopin ◽  
...  
Keyword(s):  
Pilot Study ◽  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Gastric Conduit ◽  
Simultaneous Application ◽  
Imaging Methods ◽  
Large Patient ◽  
The Impact

Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Effekt of blood flow shutdown on the vein damage when exposed to HIFU

2017 ◽  
pp. 46-50
Author(s):  
Н.Н. Петрищев ◽  
Д.Ю. Семенов ◽  
А.Ю. Цибин ◽  
Г.Ю. Юкина ◽  
А.Е. Беркович ◽  
...  
Keyword(s):  
Blood Flow ◽  
Structural Changes ◽  
Focused Ultrasound ◽  
Vena Cava ◽  
Posterior Wall ◽  
High Intensity Focused Ultrasound ◽  
Vein Wall ◽  
Ultrasound Exposure ◽  
Isolated Segment ◽  
The Impact

The purpose. In the study we investigated the impact of the partial blood flow shutdown on structural changes in the rabbit vena cava posterior wall after exposure to high-intensity focused ultrasound (HIFU). Methods. Ultrasound Exposure: frequency of 1.65 MHz, the ultrasound intensity in the focus of 13.6 kW/cm, the area of the focal spot 1 mm, continuous ultrasound, exposure for 3 seconds. Results. Immediately after HIFU exposure all layers of the vein wall showed characteristic signs of thermal damage. A week after exposure structural changes in the intima, media and adventitia was minimal in the part of vessel with preserved blood flow, and after 4 weeks the changes were not revealed. A week after HIFU exposure partial endothelium destruction, destruction of myocytes, disorganization and consolidation of collagen fibers of the adventitia were observed in an isolated segment of the vessel, and in 4 weeks endothelium restored and signs of damage in media and adventitia persisted, but were less obvious than in a week after exposure. Conclusion. The shutdown of blood flow after exposure to HIFU promotes persistent changes in the vein wall. Vein compression appears to be necessary for the obliteration of the vessel, when using HIFU-technology.

scholarly journals Advanced Constitutive Modeling of the Thixotropic Elasto-Visco-Plastic Behavior of Blood: Steady-State Blood Flow in Microtubes

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 367
Author(s):  
Konstantinos Giannokostas ◽  
Yannis Dimakopoulos ◽  
Andreas Anayiotos ◽  
John Tsamopoulos
Keyword(s):  
Blood Flow ◽  
Steady State ◽  
Constitutive Model ◽  
Blood Plasma ◽  
Constitutive Modeling ◽  
Flow Direction ◽  
Momentum Balance ◽  
Plastic Behavior ◽  
Flow Investigation ◽  
The Impact

The present work focuses on the in-silico investigation of the steady-state blood flow in straight microtubes, incorporating advanced constitutive modeling for human blood and blood plasma. The blood constitutive model accounts for the interplay between thixotropy and elasto-visco-plasticity via a scalar variable that describes the level of the local blood structure at any instance. The constitutive model is enhanced by the non-Newtonian modeling of the plasma phase, which features bulk viscoelasticity. Incorporating microcirculation phenomena such as the cell-free layer (CFL) formation or the Fåhraeus and the Fåhraeus-Lindqvist effects is an indispensable part of the blood flow investigation. The coupling between them and the momentum balance is achieved through correlations based on experimental observations. Notably, we propose a new simplified form for the dependence of the apparent viscosity on the hematocrit that predicts the CFL thickness correctly. Our investigation focuses on the impact of the microtube diameter and the pressure-gradient on velocity profiles, normal and shear viscoelastic stresses, and thixotropic properties. We demonstrate the microstructural configuration of blood in steady-state conditions, revealing that blood is highly aggregated in narrow tubes, promoting a flat velocity profile. Additionally, the proper accounting of the CFL thickness shows that for narrow microtubes, the reduction of discharged hematocrit is significant, which in some cases is up to 70%. At high pressure-gradients, the plasmatic proteins in both regions are extended in the flow direction, developing large axial normal stresses, which are more significant in the core region. We also provide normal stress predictions at both the blood/plasma interface (INS) and the tube wall (WNS), which are difficult to measure experimentally. Both decrease with the tube radius; however, they exhibit significant differences in magnitude and type of variation. INS varies linearly from 4.5 to 2 Pa, while WNS exhibits an exponential decrease taking values from 50 mPa to zero.

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