Use Of Intraoperative Indocyanine Green Angiography Research Articles

Evaluation of Intraoperative Anastomotic Patency with Angiography in Microsurgical Breast Reconstruction.

Microsurgical breast reconstruction is one of the most challenging, yet rewarding procedures performed by plastic surgeons. Several measures are taken to ensure safe elevation of the flap, preparation of recipient vessels, microvascular anastomosis, and flap inset. Reestablishing proper blood flow to the flap tissue after microvascular anastomosis is one of many critical steps for surgical success. Several measures to assess blood flow to the flap have been used; however, the use of indocyanine green angiography (ICGA) of the anastomosis in breast reconstruction has not been well documented. We present a series using ICGA for the evaluation of microvascular anastomosis success in breast reconstruction. Cases from patients who underwent microsurgical breast reconstruction between March 2022 and January 2023 and who had intraoperative ICGA were retrospectively reviewed. We compared the intraoperative findings on ICGA to flap success. Sixteen patients underwent bilateral deep inferior epigastric perforator flap reconstruction with intraoperative ICGA of the microvascular anastomosis, constituting 32 deep inferior epigastric perforator flaps. The ICGA demonstrated return of blood flow in all the flaps after microvascular anastomosis and no flap loss in our sample population. Nine flaps required additional drainage using the superficial inferior epigastric vein, and the superficial circumflex vein was used for additional drainage in one of the flaps. The use of intraoperative ICGA provides reliable visual feedback regarding the patency and direction of the blood flow through the microvascular anastomosed vessels. ICGA can be used as an additional tool in the plastic surgeon's armamentarium for successful breast reconstruction.

A Systematic Review of the Utility of Indocyanine Angiography in Autologous Breast Reconstruction.

In the last decade, a number of studies have demonstrated the utility of indocyanine green (ICG) angiography in predicting mastectomy skin flap necrosis for immediate breast reconstruction. However, data are limited to investigate this technique for autologous breast reconstruction. Although it may have the potential to improve free flap outcomes, there has not been a large multicenter study to date that specifically addresses this application. A thorough literature review based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was conducted. All studies that examined the use of intraoperative ICG angiography or SPY to assess perfusion of abdominally based free flaps for breast reconstruction from January 1, 2000, to January 1, 2020, were included. Free flap postoperative complications including total flap loss, partial flap loss, and fat necrosis were extracted from selected studies. Nine relevant articles were identified, which included 355 patients and 824 free flaps. A total of 472 free flaps underwent clinical assessment of perfusion intraoperatively, whereas 352 free flaps were assessed with ICG angiography. Follow-up was from 3 months to 1 year. The use of ICG angiography was associated with a statistically significant decrease in flap fat necrosis in the follow-up period (odds ratio = 0.31, P = 0.02). There was no statistically significant difference for total or partial flap loss. From this systematic review, it can be concluded that ICG angiography may be an effective and efficient way to reduce fat necrosis in free flap breast reconstruction and may be a more sensitive predictor of flap perfusion than clinical assessment alone. Future prospective studies are required to further determine whether ICG angiography may be superior to clinical assessment in predicting free flap outcomes.

Indocyanine Green Angiography in Breast Reconstruction: Utility, Limitations, and Search for Standardization.

A comprehensive literature search of articles pertaining to ICGA in breast reconstruction surgery was performed. The overall findings of the articles are outlined here by surgical procedure: skin-sparing and nipple-sparing mastectomy, implant-based reconstruction, and autologous reconstruction. Overall, there were 133 articles reviewed, describing the use of ICGA in breast reconstruction surgery. We found that ICGA can provide valuable information that aids in flap design, anastomotic success, and perfusion assessment. We also included example photographs and videos of ICGA use at our institution. ICGA can reduce postoperative tissue loss and aid in intraoperative flap design and inset. Despite the benefits of ICGA, its technical use and interpretation have yet to be standardized, limiting its widespread acceptance.

Intraoperative Indocyanine Green (ICG) Angiography for the Identification of the Parathyroid Glands: Current Evidence and Future Perspectives.

Recently, indocyanine green (ICG) fluorescence imaging has been used for the identification of the parathyroid glands (PG) during thyroid and parathyroid surgery. However, an overall consensus on the optimal technique, the dosage, the timing of the ICG administration and finally its interpretation and clinical usefulness is still lacking evidence. The aim of this review is to investigate the use of ICG angiography during thyroidectomy and/or parathyroidectomy for identification as well as for the perfusion integrity of the parathyroid glands. The PubMed database was systematically searched for publications regarding intraoperative ICG imaging in patients that undergo thyroidectomy or parathyroidectomy. Eighteen publications reporting on 612 patients, namely 71 parathyroidectomy and 541 thyroidectomy patients met the inclusion criteria. Eleven publications reported the use of ICG angiography for the identification of the parathyroid glands during thyroidectomy and seven during parathyroidectomy for primary and secondary hyperparathyroidism. ICG fluorescence imaging is a simple, fast and reproducible method capable of intraoperatively visualizing and assessing the function of parathyroid glands, and can, therefore, assist surgeons in their decision-making. Despite all this, ICG fluorescence imaging technique for PG detection still lacks standardization and further studies are needed to establish its clinical utility.

Improved Arterial Preservation Achieved by Combined Use of Indocyanine Green Angiography and Doppler Detector During Microsurgical Subinguinal Varicocelectomy

Objectives: The microsurgical approach is considered the most reliable procedure in varicocelectomy. However, as there are difficulties in identifying the spermatic artery at the peripheral level, we had introduced intraoperative indocyanine green angiography (ICGA) for identification of arteries. In this study, we further investigated the usefulness of intraoperative ICGA in combination with an ordinary Doppler detector in microsurgical subinguinal varicocelectomy. Methods: A total of 140 men who underwent microsurgical subinguinal varicocelectomy at Gunma University Hospital were included. An operating microscope equipped with a near-infrared charge-coupled device was used for intraoperative ICGA. After exposing the vessels, arteries were identified using endoscopic vision only or with assistance of Doppler detector or ICGA, or of both. The number of preserved arteries was compared among the groups. Results: ICGA clearly visualized the internal spermatic arteries in all cases, allowing the surgeon to perform real-time identification and isolation of the spermatic artery intraoperatively. The use of ICGA or Doppler detector significantly increased the number of preserved arteries compared to the microscope-only operation from 1.11 to 1.75 (p < 0.05) and 1.57 (p < 0.05), respectively. The additional use of ICGA with Doppler detector further increased the number of preserved arteries to 2.41 (p < 0.05). Conclusions: Intraoperative ICGA facilitated safe and quick microsurgical subinguinal varicocelectomy by enabling visualization of thin spermatic cord blood vessels. Improved preservation of thin arteries, which is essential for patients with infertility, can be achieved with the combined use of ICGA and ordinary Doppler detector.

The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation.

Indocyanine green (ICG) enhanced fluorescence imaging is recent innovation as the "real-time intraoperative imaging" technique. Many clinical studies have been reported in the literature which use different devices and techniques that employ various doses and usages of ICG as a non-specific contrast agent. Several groups have performed studies in endocrine surgery, especially with regards to parathyroid-related outcomes after thyroid and parathyroid surgery. However, there is no consensus on the technical details that should be applied. With this study, we aimed to review the current literature on potential use of intraoperative ICG angiography for evaluating parathyroid gland (PTG) preservation.

MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY Yasuhiro Shibata, Sota Kurihara, Seiji Arai, Takeshi Miyao, Yoshiyuki Miyazawa, Yoshitaka Sekine, Hidekazu Koike, Kazuto Ito, Tetsuya Nakamura, and Kazuhiro Suzuki Yasuhiro ShibataYasuhiro Shibata More articles by this author , Sota KuriharaSota Kurihara More articles by this author , Seiji AraiSeiji Arai More articles by this author , Takeshi MiyaoTakeshi Miyao More articles by this author , Yoshiyuki MiyazawaYoshiyuki Miyazawa More articles by this author , Yoshitaka SekineYoshitaka Sekine More articles by this author , Hidekazu KoikeHidekazu Koike More articles by this author , Kazuto ItoKazuto Ito More articles by this author , Tetsuya NakamuraTetsuya Nakamura More articles by this author , and Kazuhiro SuzukiKazuhiro Suzuki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2800AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicoceles are present in 20 to 30% of men with infertility; moreover, up to 10% of men with varicoceles experience scrotal pain. Varicocelectomy improves testicular function and may prevent the accelerated decline in sperm parameters and testosterone levels observed in men with varicoceles. Many studies have indicated that microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles with regard to spontaneous pregnancy outcomes and complication rates; however, the difficulty in identifying testicular arteries that should be spared is a limitation of this technique. We previously reported the usefulness of intraoperative indocyanine green angiography (ICGA) to detect the thin arteries. In the present study, we assessed the feasibility of ICGA during microsurgical subinguinal varicocelectomy in comparison with standard procedures. METHODS Microsurgical subinguinal varicocelectomy using ICGA was performed in 48 patients with infertility or chronic pain associated with varicoceles. After exposure of the spermatic cord blood vessels, ICG was injected intravenously to identify and isolate the testicular artery. Intraoperative Doppler blood flow meter was also performed in 29 cases to compare both procedures for detection of the artery. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. Seventy-eight cases without ICGA use were included as the control group, to determine the efficacy of the ICGA procedure. RESULTS The testicular artery was clearly identified by ICGA. The average operation time significantly decreased from 81.8 to 66.2 minutes with the use of ICGA. The number of preserved arteries was significantly increased by ICGA from 1.16 to 1.77. In 15 ICGA cases, very thin arteries that were undetectable with normal light view or Doppler study could be preserved. CONCLUSIONS Microsurgical subinguinal varicocelectomy using intraoperative ICGA enabled a faster procedure and secure preservation of testicular arteries. We believe that this is a significant surgical procedure for the treatment of varicoceles, especially for infertility patients in whom preservation of maximal blood supply is desired. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1202-e1203 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yasuhiro Shibata More articles by this author Sota Kurihara More articles by this author Seiji Arai More articles by this author Takeshi Miyao More articles by this author Yoshiyuki Miyazawa More articles by this author Yoshitaka Sekine More articles by this author Hidekazu Koike More articles by this author Kazuto Ito More articles by this author Tetsuya Nakamura More articles by this author Kazuhiro Suzuki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Assessment of Fibula Flap Skin Perfusion in Patients Undergoing Oromandibular Reconstruction

Complications of partial flap necrosis contribute substantially to morbidity in patients who undergo head and neck reconstructive surgery. To assess the usefulness of clinical findings, intraoperative fluorescein angiography, and intraoperative indocyanine green angiography (ICGA) for evaluation of flap skin paddle perfusion in patients undergoing oromandibular reconstruction who are at high risk of partial skin paddle necrosis. Retrospective medical record review from May 21, 1996, to May 27, 2015, at a tertiary care academic medical center. Participants were 73 patients who underwent reconstruction of through-and-through defects of the mucosa, mandible, and skin using fibula free flaps that contained large bilobed skin paddles. The rates of partial skin paddle necrosis and revision reconstructive surgery. The rates of partial flap necrosis were 8% (n = 2) among 25 patients in whom the skin paddle was trimmed based on ICGA and 33% (n = 16) among 48 patients in whom the skin paddle was trimmed according to clinical findings (P = .02). The rates of revision reconstructive surgery were 20% (5 of 25) when flap skin paddles were trimmed using ICGA and 42% (20 of 48) when trimmed per clinical findings (P = .06). The use of ICGA may reduce the risk of partial skin flap necrosis in free flaps used in patients undergoing head and neck reconstruction who are at high risk of developing flap necrosis. Indocyanine green angiography imaging should be considered in any flap in which skin paddle viability is uncertain based on clinical findings and in patients in whom the skin paddle extends beyond the primary and adjacent angiosomes. 3.

The Use of Indocyanine Green Videoangiography to Optimize the Dural Opening for Intracranial Parasagittal Lesions

We describe our clinical experience with the use of indocyanine green (ICG) videoangiography to delineate the locations of the cortical draining veins before dural opening in 3 cases of parasagittal lesions. With this technique, the veins are marked through the dura, and then the dura can be opened precisely to avoid cortical venous injury. To demonstrate in a clinical series the adjunct use of intraoperative ICG angiography to optimize the dural opening for parasagittal lesions. We describe 3 cases of parasagittal lesions, 2 meningiomas, and 1 arteriovenous malformation treated using the described technique. Once the dura had been exposed, ICG at a dose of 0.25 mg/kg was injected into the patient's peripheral vein as a bolus. When the dye reached the illuminated field of interest, ICG fluorescence was induced by the use of a light source with a wave-length ICG absorption band. Thereafter, the dural cortical veins were marked through the dura and precisely opened, avoiding cortical venous injury. Indocyanine green video angiography is a safe, fast, inexpensive, and accurate investigation that allows the surgeon to strategically plan and protect important parasagittal dural venous drainage during craniotomy.