Predicting the survival of experimental ischaemic small bowel using intraoperative near-infrared fluorescence angiography
Open accessAbstract
Background: Predicting the long-term viability of ischaemic bowel during surgery is challenging. The aim was to determine whether intraoperative near-infrared angiography (NIR-AG) of ischaemic bowel might provide metrics that were predictive of long-term outcome. Methods: NIR-AG using indocyanine green was performed on 24 pigs before, and after inducing bowel ischaemia to determine the feasibility of NIR-AG for detecting compromised perfusion. Contrast-to-background ratio (CBR) over time was measured in regions of interest throughout the bowel, and various metrics of the CBR–time curve were developed. Sixty rat small bowels, with or without strangulation, were imaged during surgery and on day 3 after operation. CBR metrics and clinical findings were assessed quantitatively for their ability to predict animal survival, histological grade of ischaemic injury and visible necrosis on day 3. Results: In ischaemic pig small bowel, various qualitative and quantitative CBR metrics appeared to correlate with bowel injury as a function of distance from normal bowel. In rats, intraoperative clinical assessment showed high specificity but low sensitivity for predicting outcome on day 3 after operation. Qualitative patterns of the CBR–time curve, such as absence of an arterial inflow peak and presence of a NIR filling defect, resulted in better prediction of survival (90 per cent), histological grade (85 per cent) and visible necrosis on day 3 (92 per cent). Conclusion: Survival of ischaemic bowel was predicted by intraoperative NIR-AG with greater accuracy than clinical evaluation alone.
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In an experimental setting even small differences in perfusion can be reliably determined by ICGFI.
“In an experimental setting even small differences in perfusion can be reliably determined by ICGFI.”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [175]
The Results describe distinct fluorescence patterns in normal and ischaemic pig bowel, supporting the method’s ability to detect some perfusion differences. But the Discussion reports that short (2–3 cm) ischaemic segments did not alter the measured curve compared with non-ischaemic bowel; the arterial inflow peak was lost only beyond 4 cm. The claim that even small differences can be reliably determined overstates these findings (page numbers unavailable in our copy). (LLM, conf=0.87)
Experimental — accuracy not yet measuredEvaluation of the maximum fluorescence intensity alone resulted in only a slightly better bowel evaluation compared with visual evaluation.
“Evaluation of the maximum fluorescence intensity alone resulted in only a slightly better bowel evaluation compared with visual evaluation. 175”
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Shemilov, R. R., Kornyushin, O. V., Sonin, D. L., Борисович, Н. Д., Danilova, E. S., Struĭ, A. V., Zhuravsky, S. G., Toropova, Y. G., Papayan, G. V., Данилов, И. Н., et al. (2025) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-234-2-154-162
Kitada, K., HONDA, K., Hisamune, R., & Lee, S. (2025) · Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) · doi:10.3919/jjsa.86.401
- Authors
- Matsui, A., Winer, J. H., Laurence, R. G., & Frangioni, J. V.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Frangioni, J V
- ORCID
- Matsui, A
- Venue
- British Journal of Surgery
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-27
- Volume
- 98
- Issue
- 12
- Pages
- 1725-1734
- ISSN
- 0007-1323 (ISSN-L)
- 1365-2168
- PMC
- PMC3235697
- OpenAlex
- W1993318984
- Cited by
- 69
- References
- 24
- Citations by year
- 2025: 7 · 2024: 5 · 2023: 4 · 2022: 5 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 7 · 2017: 2 · 2016: 4 · 2015: 4 · 2014: 2 · 2013: 8 · 2012: 4
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- British journal of surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- indocyanine green, intestinal ischemia, intestinal necrosis, intestinal perfusion, animal models
- MeSH terms
- Animals, Coloring Agents, Feasibility Studies, Female, Fluorescein Angiography, Indocyanine Green, Intestinal Obstruction, Intestine, Small, Intraoperative Period, Ischemia, Male, Swine, Survival Analysis, Rats, Sprague-Dawley, Rats
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