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Zetzmann K, Papatheodorou N, Rühl E, Yagshyyev S, Haney B, Moosmann O, Li Y, Meyer A, Knieling F, Behrendt CA, Lang W, Rother U. Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study. SAGE Open Med 2024; 12:20503121241263244. [PMID: 39055279 PMCID: PMC11271087 DOI: 10.1177/20503121241263244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Although major amputations can often be avoided due to evolving methods of endovascular and surgical revascularizations techniques, in patients with chronic limb-threatening ischemia, it is still necessary in some cases. Aim of this study was the detection of wound healing disorders through intraoperative microcirculation measurements in major limb amputations. Materials and methods In this single-center clinical study, patients with an indication for major amputation were enrolled prospectively. Cause of amputation, patients' comorbidities including cardiovascular risk profile were assessed. Macrocirculation, as well as microcirculation were assessed. Microcirculation measurements were performed by fluorescence angiography with the administration of indocyanine green. A preoperative measurement was obtained at the amputation level, followed by three additional measurements of the amputation stump postoperatively. Wound healing was monitored and correlated with the microcirculatory findings, based on the perfusion parameters ingress and ingress rate, calculated in the indocyanine green fluorescence video sequences of the amputation stumps. Results Forty-five patients were enrolled, including 19 (42%) below-the-knee amputations and 26 (58%) above-the-knee amputations. When considering the need for revision, a change in the microperfusion parameters was observed postoperatively. The mean value for ingress was significantly lower directly postoperatively in stumps requiring revisions (5 ± 0 A.U. versus 40.5 ± 42.5 A.U., p < 0.001). The mean value of ingress rate behaved similarly (0.15 ± 0.07 A.U./s versus 2.8 ± 5.0 A.U./s, p = 0.005). The evaluation of indocyanine green measurements when wound healing disorders occurred also showed nonsignificant differences in the mean values. Conclusion Fluorescence angiography after major lower limb amputations appears to be an option of depicting microperfusion. Especially, the early postoperative detection of reduced perfusion can indicate a subsequent need for revision. Therefore, this method could possibly serve as a tool for intraoperative quality control after major limb amputation.
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Affiliation(s)
- Katharina Zetzmann
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nikolaos Papatheodorou
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Eva Rühl
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Shatlyk Yagshyyev
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Briain Haney
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oxana Moosmann
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yi Li
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Meyer
- Department of Vascular Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
- Medical School Berlin, Berlin, Germany
| | - Ferdinand Knieling
- Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Klinik Wandsbek, Asklepios Medical School, Hamburg, Germany
| | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich Rother
- Department of Vascular Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Sakkab R, MacRae TM, Morgan C, Longobardi J. Indocyanine Green Fluorescence Angiography in Minor Lower Extremity Amputations: A Useful Technique? J Foot Ankle Surg 2023; 62:267-271. [PMID: 36055879 DOI: 10.1053/j.jfas.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/11/2022] [Accepted: 07/16/2022] [Indexed: 02/03/2023]
Abstract
Complications remain despite conventional methods aimed at improving survivorship of lower extremity amputations. High rates of wound dehiscence, readmission, and revision surgery warrant the development of innovative methods to improve amputation survivorship. One such method employs the use of indocyanine green dye (ICG); an inert chemical injected intraoperatively which can be used to visualize dermal blood flow in real time. There is little objective data available to help guide the use of indocyanine green in limb salvage procedures. The present study compares a group of 31 patients undergoing minor lower extremity amputation with the use of indocyanine green with a control group of 62 patients in which traditional methods were used. Minimum follow-up of 9 months was obtained, leaving 93 patients in total for analysis. Success was defined as a healed amputation within 60 days of follow-up. Uneventful amputation healing occurred in 35.5% and 33.9% of indocyanine green and control patients, respectively. Overall, there was no significant difference in outcomes between groups (p = .965), or success versus failure (p = 1.0). Patient undergoing minor lower extremity amputation with the use of ICG fluorescence angiography did not have statistically inferior outcomes to patients who underwent amputations at the same level with traditional assessments of perfusion. Further research involving the use of this technique is warranted.
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Affiliation(s)
- Ramez Sakkab
- Podiatric Surgical Resident, Scripps Mercy Hospital, San Diego, CA.
| | - Tyler M MacRae
- Podiatric Surgical Resident, Scripps Mercy Hospital, San Diego, CA
| | - Craig Morgan
- Attending Surgeon, Scripps Mercy Hospital, San Diego, CA
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Van Den Hoven P, Osterkamp J, Nerup N, Svendsen MBS, Vahrmeijer A, Van Der Vorst JR, Achiam MP. Quantitative perfusion assessment using indocyanine green during surgery - current applications and recommendations for future use. Langenbecks Arch Surg 2023; 408:67. [PMID: 36700999 PMCID: PMC9879827 DOI: 10.1007/s00423-023-02780-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Incorrect assessment of tissue perfusion carries a significant risk of complications in surgery. The use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) presents a possible solution. However, only through quantification of the fluorescence signal can an objective and reproducible evaluation of tissue perfusion be obtained. This narrative review aims to provide an overview of the available quantification methods for perfusion assessment using ICG NIR fluorescence imaging and to present an overview of current clinically utilized software implementations. METHODS PubMed was searched for clinical studies on the quantification of ICG NIR fluorescence imaging to assess tissue perfusion. Data on the utilized camera systems and performed methods of quantification were collected. RESULTS Eleven software programs for quantifying tissue perfusion using ICG NIR fluorescence imaging were identified. Five of the 11 programs have been described in three or more clinical studies, including Flow® 800, ROIs Software, IC Calc, SPY-Q™, and the Quest Research Framework®. In addition, applying normalization to fluorescence intensity analysis was described for two software programs. CONCLUSION Several systems or software solutions provide a quantification of ICG fluorescence; however, intraoperative applications are scarce and quantification methods vary abundantly. In the widespread search for reliable quantification of perfusion with ICG NIR fluorescence imaging, standardization of quantification methods and data acquisition is essential.
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Affiliation(s)
- P Van Den Hoven
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - J Osterkamp
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
| | - N Nerup
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
| | - M B S Svendsen
- CAMES Engineering, Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Alexander Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Van Der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
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4
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Usefulness of indocyanine green fluorescence angiography for the urgent decision of the level of limb amputation. JPRAS Open 2022; 33:119-121. [PMID: 35865082 PMCID: PMC9293730 DOI: 10.1016/j.jpra.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
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Van Den Hoven P, Goncalves LN, Quax PHA, Van Rijswijk CSP, Van Schaik J, Schepers A, Vahrmeijer AL, Hamming JF, Van Der Vorst JR. Perfusion Patterns in Patients with Chronic Limb-Threatening Ischemia versus Control Patients Using Near-Infrared Fluorescence Imaging with Indocyanine Green. Biomedicines 2021; 9:biomedicines9101417. [PMID: 34680534 PMCID: PMC8533354 DOI: 10.3390/biomedicines9101417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/01/2023] Open
Abstract
In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.
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Affiliation(s)
- Pim Van Den Hoven
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Lauren N. Goncalves
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Paulus H. A. Quax
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | | | - Jan Van Schaik
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Alexander L. Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
| | - Joost R. Van Der Vorst
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (P.V.D.H.); (L.N.G.); (P.H.A.Q.); (J.V.S.); (A.S.); (A.L.V.); (J.F.H.)
- Correspondence: ; Tel.: +31-71-529-9143
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Arkoudis NA, Katsanos K, Inchingolo R, Paraskevopoulos I, Mariappan M, Spiliopoulos S. Quantifying tissue perfusion after peripheral endovascular procedures: Novel tissue perfusion endpoints to improve outcomes. World J Cardiol 2021; 13:381-398. [PMID: 34621485 PMCID: PMC8462037 DOI: 10.4330/wjc.v13.i9.381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Peripheral artery disease (PAD) is a flow-limiting condition caused by narrowing of the peripheral arteries typically due to atherosclerosis. It affects almost 200 million people globally with patients either being asymptomatic or presenting with claudication or critical or acute limb ischemia. PAD-affected patients display increased mortality rates, rendering their management critical. Endovascular interventions have proven crucial in PAD treatment and decreasing mortality and have significantly increased over the past years. However, for the functional assessment of the outcomes of revascularization procedures for the treatment of PAD, the same tests that have been used over the past decades are still being employed. Those only allow an indirect evaluation, while an objective quantification of limb perfusion is not feasible. Standard intraarterial angiography only demonstrates post-intervention vessel patency, hence is unable to accurately estimate actual limb perfusion and is incapable of quantifying treatment outcome. Therefore, there is a significant necessity for real-time objectively measurable procedural outcomes of limb perfusion that will allow vascular experts to intraoperatively quantify and assess outcomes, thus optimizing treatment, obviating misinterpretation, and providing significantly improved clinical results. The purpose of this review is to familiarize readers with the currently available perfusion-assessment methods and to evaluate possible prospects.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Radiology Department, Interventional Radiology Unit, Attikon University General Hospital, Athens 12461, Greece
| | - Konstantinos Katsanos
- Interventional Radiology Department, Patras University Hospital, PATRAS 26441, Greece
| | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Ioannis Paraskevopoulos
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, United Kingdom
| | - Martin Mariappan
- Department of Clinical Radiology, Interventional Radiology Unit, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB15 5EY, United Kingdom
| | - Stavros Spiliopoulos
- 2nd Radiology Department, Interventional Radiology Unit, School of Medicine, National and Kapodistrian University of Athens, Athens 12461, Greece
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Van Den Hoven P, Van Den Berg SD, Van Der Valk JP, Van Der Krogt H, Van Doorn LP, Van De Bogt KEA, Van Schaik J, Schepers A, Vahrmeijer AL, Hamming JF, Van Der Vorst JR. Assessment of Tissue Viability Following Amputation Surgery Using Near-Infrared Fluorescence Imaging With Indocyanine Green. Ann Vasc Surg 2021; 78:281-287. [PMID: 34182113 DOI: 10.1016/j.avsg.2021.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with chronic limb threatening ischemia have a risk of undergoing a major amputation within 1 year of nearly 30% with a substantial risk of re-amputation since wound healing is often impaired. Quantitative assessment of regional tissue viability following amputation surgery can identify patients at risk for impaired wound healing. In quantification of regional tissue perfusion, near-infrared (NIR) fluorescence imaging using Indocyanine Green (ICG) seems promising. METHODS This pilot study included adult patients undergoing lower extremity amputation surgery due to peripheral artery disease or diabetes mellitus. ICG NIR fluorescence imaging was performed within 5 days following amputation surgery using the Quest Spectrum PlatformⓇ. Following intravenous administration of ICG, the NIR fluorescence intensity of the amputation wound was recorded for 10 minutes. The NIR fluorescence intensity videos were analyzed and if a fluorescence deficit was observed, this region was marked as "low fluorescence." All other regions were marked as "normal fluorescence." RESULTS Successful ICG NIR fluorescence imaging was performed in 10 patients undergoing a total of 15 amputations. No "low fluorescence" regions were observed in 11 out of 15 amputation wounds. In 10 out of these 11 amputations, no wound healing problems occurred during follow-up. Regions with "low fluorescence" were observed in 4 amputation wounds. Impaired wound healing corresponding to these regions was observed in all wounds and a re-amputation was necessary in 3 out of 4. When observing time-related parameters, regions with low fluorescence had a significantly longer time to maximum intensity (113 seconds vs. 32 seconds, P = 0.003) and a significantly lesser decline in outflow after five minutes (80.3% vs. 57.0%, P = 0.003). CONCLUSIONS ICG NIR fluorescence imaging was able to predict postoperative skin necrosis in all four cases. Quantitative assessment of regional perfusion remains challenging due toinfluencing factors on the NIR fluorescence intensity signal, including camera angle, camera distance and ICG dosage. This was also observed in this study, contributing to a large variety in fluorescence intensity parameters among patients. To provide surgeons with reliable NIR fluorescence cut-off values for prediction of wound healing, prospective studies on the intra-operative use of this technique are required. The potential prediction of wound healing using ICG NIR fluorescence imaging will have a huge impact on patient mortality, morbidity as well as the burden of amputation surgery on health care.
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Affiliation(s)
- Pim Van Den Hoven
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Simen D Van Den Berg
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurrian P Van Der Valk
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke Van Der Krogt
- Department of Medical Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | - Louk P Van Doorn
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen E A Van De Bogt
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Van Schaik
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alex L Vahrmeijer
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost R Van Der Vorst
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Interpretation of Near-Infrared Imaging in Acute and Chronic Wound Care. Diagnostics (Basel) 2021; 11:diagnostics11050778. [PMID: 33925990 PMCID: PMC8144992 DOI: 10.3390/diagnostics11050778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Vascular assessment is a critical component of wound care. Current routine noninvasive vascular studies have limitations which can give a false sense of security of the presence of adequate perfusion for healing. Near-infrared imaging modalities can serve as an additional diagnostic assessment of wounds in which adequate perfusion is a concern. Correct interpretation of near-infrared images obtained is critical as subtleties that exist in the acute and chronic wound population goes beyond the interpretation that increased signal is consistent with adequate perfusion for healing. The objective of this paper is to educate providers on the correct interpretation of this point-of-care imaging modality in day-to-day wound-care practice to guide clinical decision-making for rapid wound resolution.
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9
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Poredos P. Involvement of microcirculation in critical ischemia: how to identify it? INT ANGIOL 2020; 39:492-499. [PMID: 32594670 DOI: 10.23736/s0392-9590.20.04428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Critical limb ischemia represents the most severe pattern of peripheral arterial disease (PAD) associated with the high risk of major amputation, cardiovascular events and death. The diagnosis and management of critical limb ischemia (CLI) is often challenging. Systolic ankle and toe pressure measurements are considered to be the basic techniques for the identification of PAD. However, they provide rough insight into the dependent local tissue perfusion. Furthermore, those techniques do not enable investigation of microcirculation which has crucial role in the pathogenesis of CLI. Some patients with mild deterioration of macrocirculation develop CLI if microcirculation is affected. Investigation of perfusion on macro- and local microcirculatory level enables more effective treatment: revascularization of the angiosome-related artery. The technologies capable of assessing limb tissue oxygenation or perfusion on microcirculatory level enable direct assessment of distant tissue oxygenation. Transcutaneous oxygen tension (TcPO2) measurement which was introduced in clinical practice represents one of the objective criteria for the diagnosis of CLI. Main weakness of this technique as well as laser Doppler flow measurement is low penetrance from the skin surface. Measurement of tissue blood flow on microcirculatory level can be performed with indocyanine green fluorescent imaging (ICG), contrast-enhanced magnetic resonance and vital microscopy. ICG is promising method which provides excellent informative image of tissue perfusion. However, it offers little quantitative information. Investigation of microcirculation in patients with CLI is of outmost importance because it enables insight in local tissue perfusion and oxygenation, which represents the basis of identification of most ischemic regions and provide more successful angiosome related revascularization of an affected artery.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, University Medical Centre Ljubljana (UMCL), Ljubljana, Slovenia - .,Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA -
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10
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Poredoš P. Fluorescence angiography – a diagnostic tool for limb perfusion and critical limb ischemia. VASA 2020; 49:165-166. [DOI: 10.1024/0301-1526/a000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Pavel Poredoš
- Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, USA
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11
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van den Hoven P, Ooms S, van Manen L, van der Bogt KEA, van Schaik J, Hamming JF, Vahrmeijer AL, van der Vorst JR, Mieog JSD. A systematic review of the use of near-infrared fluorescence imaging in patients with peripheral artery disease. J Vasc Surg 2020; 70:286-297.e1. [PMID: 31230648 DOI: 10.1016/j.jvs.2018.11.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/19/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index plays an important role. However, results of the ankle-brachial index are unreliable in patients with severe media sclerosis. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) can provide information about tissue perfusion and has already been studied in oncologic, reconstructive, and cardiac surgery. For patients with PAD, this technique might give insight into skin perfusion and thereby guide treatment. We performed a systematic review of the literature on the use of NIR fluorescence imaging in patients with PAD. METHODS PubMed, MEDLINE, Embase, and Cochrane were searched for articles and abstracts on the application of NIR fluorescence imaging using ICG as fluorescent dye in patients with PAD. Our search strategy combined the terms "fluorescence," "ICG," or synonyms and "peripheral artery disease" or synonyms. The extracted data included fluorescence parameters and test characteristics for diagnosis of PAD. RESULTS Twenty-three articles were found eligible for this review using 18 different parameters for evaluation of the fluorescence signal intensity. NIR fluorescence imaging was used for four main indications: diagnosis, quality control in revascularization, guidance in amputation surgery, and visualization of vascular structures. For the diagnosis of PAD, NIR fluorescence imaging yields a sensitivity ranging from 67% to 100% and a specificity varying between 72% and 100%. Significant increases in multiple fluorescence parameters were found in comparing patients before and after revascularization. CONCLUSIONS NIR fluorescence imaging can be used for several indications in patients with PAD. NIR fluorescence imaging seems promising in diagnosis of PAD and guidance of surgeons in treatment, especially in patients in whom current diagnostic methods are not applicable. Further standardization is needed to reliably use this modality in patients with PAD.
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Affiliation(s)
- Pim van den Hoven
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Ooms
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Labrinus van Manen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - J Sven D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Hentzen JE, de Jongh SJ, Hemmer PH, van der Plas WY, van Dam GM, Kruijff S. Molecular fluorescence-guided surgery of peritoneal carcinomatosis of colorectal origin: A narrative review. J Surg Oncol 2018; 118:332-343. [PMID: 29938400 PMCID: PMC6174973 DOI: 10.1002/jso.25106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 12/14/2022]
Abstract
Patients with peritoneal carcinomatosis (PC) from colorectal origin may undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) as a curative approach. One major prognostic factor that affects survival is completeness of cytoreduction. Molecular Fluorescence Guided Surgery (MFGS) is a novel intraoperative imaging technique that may improve tumor identification in the future, potentially preventing over- and under-treatment in these patients. This narrative review outlines a chronological overview of MFGS development in patients with PC of colorectal origin.
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Affiliation(s)
- Judith E.K.R. Hentzen
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Steven J. de Jongh
- Department of Gastroenterology and Hepatology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Patrick H.J. Hemmer
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Willemijn Y. van der Plas
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
| | - Gooitzen M. van Dam
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Nuclear Medicine and Molecular Imaging and Intensive Care, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Schelto Kruijff
- Department of Surgery, Division of Surgical Oncology, University Medical Centre GroningenUniversity of GroningenGroningenThe Netherlands
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13
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De Silva GS, Saffaf K, Sanchez LA, Zayed MA. Amputation stump perfusion is predictive of post-operative necrotic eschar formation. Am J Surg 2018; 216:540-546. [PMID: 29789123 PMCID: PMC6129216 DOI: 10.1016/j.amjsurg.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/22/2018] [Accepted: 05/06/2018] [Indexed: 12/26/2022]
Abstract
Background A large proportion of patients develop poor amputation stump healing. We hypothesize that Laser-Assisted Fluorescent Angiography (LAFA) can predict inadequate tissue perfusion and healing. Methods Over an 8-month period we reviewed all patients who underwent lower extremity amputation and LAFA. We evaluated intra-operative LAFA global and segmental stump perfusion, and post-operative modified Bates-Jensen (mBJS) wound healing scores. Results In 15 patients, amputation stumps with lower global perfusion demonstrated higher mBJS (P = 0.01). Lower suture-line perfusion also correlated with more eschar formation (P < 0.001). Diabetic patients had higher mBJS (P = 0.009), lower stump perfusion (P = 0.02), and increased eschar volume (P < 0.001). Conclusion LAFA is a useful adjunct for intra-operative stump perfusion assessment and can predict areas of poor stump healing and eschar formation. Diabetic patients seem to be at higher risk of stump eschar formation.
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Affiliation(s)
- Gayan S De Silva
- Washington University School of Medicine, Department of Surgery, Section of Vascular Surgery, St. Louis, MO, USA
| | - Khalid Saffaf
- Washington University School of Medicine, Department of Surgery, Section of Vascular Surgery, St. Louis, MO, USA
| | - Luis A Sanchez
- Washington University School of Medicine, Department of Surgery, Section of Vascular Surgery, St. Louis, MO, USA
| | - Mohamed A Zayed
- Washington University School of Medicine, Department of Surgery, Section of Vascular Surgery, St. Louis, MO, USA; Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA.
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14
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Alius C, Oprescu S, Balalau C, Nica AE. Indocyanine green enhanced surgery; principle, clinical applications and future research directions. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2018. [DOI: 10.25083/2559.5555/31.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Over the past decade a new emergent technology has become very popular in all fields of surgery using Indocyanine green and near infrared fluorescent optical systems. This revolutionary approach overlaps conventional and near infrared images to produce highly informative intraoperative images on the anatomy and physiology of various tissues. Near infrared fluorescence is employed for perioperative angiography in vascular mapping, assessment of anastomoses, location of sentinel lymph nodes and delineation of biliary tree anatomy, highlighting tumours and metastatic deposits, improving surgical techniques and for many other uses. A lot of researchers have reported better surgical outcomes and technique innovations facilitated by this novel technology which although in its early stages, it lights up great interest worldwide. This article reviews the principle of the method, the properties of the fluorescent dye, the main clinical applications and discusses future research directions.
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15
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Hackethal A, Hirschburger M, Eicker SO, Mücke T, Lindner C, Buchweitz O. Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery - A Critical Evaluation of Options. Geburtshilfe Frauenheilkd 2018; 78:54-62. [PMID: 29375146 PMCID: PMC5778195 DOI: 10.1055/s-0043-123937] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/07/2023] Open
Abstract
Modern surgical strategies aim to reduce trauma by using functional imaging to improve surgical outcomes. This reviews considers and evaluates the importance of the fluorescent dye indocyanine green (ICG) to visualize lymph nodes, lymphatic pathways and vessels and tissue borders in an interdisciplinary setting. The work is based on a selective search of the literature in PubMed, Scopus, and Google Scholar and the authors' own clinical experience. Because of its simple, radiation-free and uncomplicated application, ICG has become an important clinical indicator in recent years. In oncologic surgery ICG is used extensively to identify sentinel lymph nodes with promising results. In some studies, the detection rates with ICG have been better than the rates obtained with established procedures. When ICG is used for visualization and the quantification of tissue perfusion, it can lead to fewer cases of anastomotic insufficiency or transplant necrosis. The use of ICG for the imaging of organ borders, flap plasty borders and postoperative vascularization has also been scientifically evaluated. Combining the easily applied ICG dye with technical options for intraoperative and interventional visualization has the potential to create new functional imaging procedures which, in future, could expand or even replace existing established surgical techniques, particularly the techniques used for sentinel lymph node and anastomosis imaging.
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Affiliation(s)
- Andreas Hackethal
- Tagesklinik Altonaer Straße, Frauenklinik an der Elbe, Hamburg, Germany
| | | | - Sven Oliver Eicker
- Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Mücke
- Mund-Kiefer-Gesichtschirurgie, St. Josefshospital, Krefeld-Uerdingen, Germany
| | - Christoph Lindner
- Gynäkologie und Geburtshilfe, Agaplesion Diakonieklinikum Hamburg, Hamburg, Germany
| | - Olaf Buchweitz
- Tagesklinik Altonaer Straße, Frauenklinik an der Elbe, Hamburg, Germany
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16
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Li WW, Carter MJ, Mashiach E, Guthrie SD. Vascular assessment of wound healing: a clinical review. Int Wound J 2017; 14:460-469. [PMID: 27374428 PMCID: PMC7950183 DOI: 10.1111/iwj.12622] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/28/2016] [Indexed: 12/17/2022] Open
Abstract
Although macrovascular screening of patients with chronic wounds, particularly in the lower extremities, is accepted as part of clinical practice guidelines, microvascular investigation is less commonly used for a variety of reasons. This can be an issue because most patients with macrovascular disease also develop concomitant microvascular dysfunction. Part of the reason for less comprehensive microvascular screening has been the lack of suitable imaging techniques that can quantify microvascular dysfunction in connection with non-healing chronic wounds. This is changing with the introduction of fluorescence microangiography. The objective of this review is to examine macro- and microvascular disease, the strengths and limitations of the approaches used and to highlight the importance of microvascular angiography in the context of wound healing.
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17
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Mücke T, Fichter AM, Schmidt LH, Mitchell DA, Wolff KD, Ritschl LM. Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using the flow ® 800 tool. Microsurgery 2016; 37:235-242. [PMID: 27198708 DOI: 10.1002/micr.30072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/28/2016] [Accepted: 05/04/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND The decision to re-operate on a potentially ischemic free flap remains challenging. Indocyanine green videoangiography (ICG) with the FLOW® 800 tool is a method which allows an immediate qualitative conclusion about the patency of an anastomosis. Is it also able to predict the outcome of potentially compromised vascular free flaps? MATERIALS AND METHODS An epigastric flap was raised and repositioned in 79 rats. Intraoperative fluorescence angiography was performed using ICG videoangiography and the FLOW® 800 tool was applied. Six regions of interest were positioned systematically over the flap, changes of the ICG fluorescence were color coded with respect to time and 474 measurements were performed. The flap was clinically monitored for one week and the resulting necrotic areas were correlated with the ICG/FLOW® 800 results. RESULTS Mean intensity of clinically vital areas was 83.39 ± 50.96 arbitrary units (AU) and 37.33 ± 15.14 AU in necrotic areas. The receiver operating characteristic curve and Youden-Index analysis revealed that the optimal cutoff for the maximal intensity of ICG after FLOW® 800 analysis was ≤ 61.733 for the prediction of flap necrosis and > 61.733 for the prediction of flap survival (P < 0.0001; 95% CI = 0.85-0.91; Youden-Index: 0.67). The maximal intensity of ICG angiography had a specificity of 96.1% and sensitivity of 71.4%. The positive predictive value was 97.46% and the corresponding negative predictive value was 61.34%. CONCLUSION This demonstrates the potential additional value of ICG videoangiography including FLOW® 800 analyses in the postoperative monitoring of transplanted flaps. © 2016 Wiley Periodicals, Inc. Microsurgery 37:235-242, 2017.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
| | - Andreas M Fichter
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
| | - Leonard H Schmidt
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
| | - David A Mitchell
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, Germany
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18
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Azagury DE, Dua MM, Barrese JC, Henderson JM, Buchs NC, Ris F, Cloyd JM, Martinie JB, Razzaque S, Nicolau S, Soler L, Marescaux J, Visser BC. Image-guided surgery. Curr Probl Surg 2015; 52:476-520. [PMID: 26683419 DOI: 10.1067/j.cpsurg.2015.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Dan E Azagury
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Monica M Dua
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - James C Barrese
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA
| | - Nicolas C Buchs
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Frederic Ris
- Department of Surgery, University Hospital of Geneva, Clinic for Visceral and Transplantation Surgery, Geneva, Switzerland
| | - Jordan M Cloyd
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - John B Martinie
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Sharif Razzaque
- Department of Surgery, Carolinas Healthcare System, Charlotte, NC
| | - Stéphane Nicolau
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Luc Soler
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Jacques Marescaux
- IRCAD (Research Institute Against Digestive Cancer), Strasbourg, France
| | - Brendan C Visser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA.
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Bajwa A, Wesolowski R, Patel A, Saha P, Ludwinski F, Smith A, Nagel E, Modarai B. Assessment of tissue perfusion in the lower limb: current methods and techniques under development. Circ Cardiovasc Imaging 2014; 7:836-43. [PMID: 25227236 DOI: 10.1161/circimaging.114.002123] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Adnan Bajwa
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Roman Wesolowski
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Ashish Patel
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Prakash Saha
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Francesca Ludwinski
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Alberto Smith
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Eike Nagel
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.)
| | - Bijan Modarai
- From the Cardiovascular Division, Academic Department of Surgery, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at Kings Health Partners, St Thomas' Hospital, London, United Kingdom (A.B., A.P., P.S., F.L., A.S., B.M.); and Division of Imaging Sciences and Biomedical Engineering. Department of Cardiovascular Imaging, Kings College London, BHF Centre of Research Excellence, Wellcome Trust-EPSRC Medical Engineering Centre & NIHR Biomedical Research Centre at Kings Health Partners, St. Thomas' Hospital, London, United Kingdom (R.W., E.N.).
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20
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A review of indocyanine green fluorescent imaging in surgery. Int J Biomed Imaging 2012; 2012:940585. [PMID: 22577366 PMCID: PMC3346977 DOI: 10.1155/2012/940585] [Citation(s) in RCA: 793] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/01/2012] [Indexed: 02/07/2023] Open
Abstract
The purpose of this paper is to give an overview of the recent surgical intraoperational applications of indocyanine green fluorescence imaging methods, the basics of the technology, and instrumentation used. Well over 200 papers describing this technique in clinical setting are reviewed. In addition to the surgical applications, other recent medical applications of ICG are briefly examined.
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