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Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia
Abstract
Purpose Surgical exploration and bowel resection are frequently required for treating non-occlusive mesenteric ischemia. Intraoperative evaluation of intestinal perfusion is subjective and challenging. In this feasibility study, ICG fluorescence angiography was performed in order to evaluate intestinal perfusion in patients with acute mesenteric ischemia. Methods This is a retrospective analysis of 52 patients who were operated for acute mesenteric ischemia using ICG fluorescence angiography. Patients with occlusive disease requiring recanalization were excluded. The SPY and PinPoint imaging systems were used for open and laparoscopic surgery, respectively. Intraoperative macroscopic assessment of perfusion was compared with the ICG angiography results. Results Surgical exploration was performed for ischemia of the colon (n = 12), the small bowel (n = 23), or both (n = 16). One patient had ischemia of the esophagus and stomach. All patients had a preoperative CT angiography to rule out stenosis or occlusion of the mesenteric vessels. In 18 cases (34.6%), ICG fluorescence angiography provided information that was supplemental to macroscopic evaluation, but most patients did not survive the postoperative course. However, in six of those cases (11.5%), ICG angiography led to a major change in operative strategy resulting in a significant clinical benefit for those patients. For two cases, ICG fluorescence produced false negative results. Discussion ICG tissue angiography is feasible and technically reliable for evaluating intestinal perfusion in acute mesenteric ischemia and led to a significant clinical benefit in 11% of our patients. A relevant discrepancy between surgical visual assessment and fluorescence angiography was found in 35% of the cases, which may help to define resection margins more accurately and thus support surgical decision-making.
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Several experimental and clinical reports have demonstrated the feasibility of ICGFI in mesenteric ischaemia for the evaluation of intestinal viability, using various imaging systems and different ICG dosages.
“However, several experimental and clinical reports have demonstrated the feasibility of ICGFI in mesenteric ischaemia for the evaluation of intestinal viability, using various imaging systems and different ICG dosages.”
In a series of 52 patients with NOMI, ICGFI led to less aggressive bowel resection than based on clinical assessment in six patients and was false negative in two patients.
“In a series of 52 patients with NOMI, ICGFI led to less aggressive bowel resection than based on clinical assessment in six patients and was false negative in two patients. 168”
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Metadata
- Authors
- Karampinis, I., Keese, M., Jakob, J., Stasiunaitis, V., Gerken, A., Attenberger, U., Post, S., Kienle, P., & Nowak, K.
- Affiliations
- Heidelberg University (DE)
- Corresponding author
- Karampinis, Ioannis
- ORCID
- Venue
- Journal of Gastrointestinal Surgery
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 22
- Issue
- 12
- Pages
- 2117-2124
- ISSN
- 1091-255X (ISSN-L)
- OpenAlex
- W2814154181
- Cited by
- 104
- References
- 24
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 15 · 2023: 9 · 2022: 14 · 2021: 19 · 2020: 10 · 2019: 7 · 2018: 1
- FWCI
- 9.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastrointestinal Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Keywords
- indocyanine green angiography, acute mesenteric ischemia, intestinal perfusion, bowel resection, intraoperative assessment, surgical margins, small bowel ischemia, ischemic colitis, surgical decision-making, laparoscopic surgery
- MeSH terms
- Computed Tomography Angiography, Adult, Aged, Angiography, Colon, Coloring Agents, Esophagus, Female, Fluorescence, Humans, Indocyanine Green, Intestine, Small, Intestines, Ischemia, Male, Middle Aged, Laparoscopy, Retrospective Studies, Stomach, Digestive System Surgical Procedures, Optical Imaging, Mesenteric Ischemia
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