Intraoperative quality assessment of tissue perfusion with indocyanine green (ICG) in a porcine model of mesenteric ischemia
Open accessAbstract
Background: Mesenteric ischemia is a severe and potentially lethal event. Assessment of intestine perfusion is eminently depending on the skills, and the experience of the surgeon. Thus, the therapy is biased by the right evaluation. Aim of this study is to determine the applicability, and the usefulness of fluorescent-imaging (FI) with indocyanine green (ICG) in a porcine model of mesenteric ischemia. Second end-point is the verification of a visual and quantitative assessment tool of the intestinal perfusion. Methods: In 18 pigs (54,2 ±2,9kg) an occlusion of a side-branch of the mesenteric artery was performed for 3 (group I, n = 7), 6 (group II, n = 7), and 10 hours (group III, n = 4). After reperfusion a 60 minutes observation period was carried out. 3 regions of interest were defined: ischemic bowel (D1), transitional zone (D2), and non-ischemic bowel (D3). ICG-FI was performed during baseline (T0), occlusion (T1), reperfusion (T2) and after an observation period of 60 minutes (T4). Results: All experiments could be finished successfully. ICG-FI was assessed using assessment of background-subtracted peak fluorescence intensity (BSFI), slope of fluorescence intensity (SFI), and a baseline adjusted ratio of both parameters. ICG-FI confirmed loss of perfusion in D1, decreased perfusion in D2, and increased perfusion in D3. After reperfusion ICG-FI increased in group 2 due to a severe tissue damage resulting in a capillary leakage. In group I ICG-FI was equal to baseline values indicating the totally reversible loss of perfusion. Conclusion: Using ICG-FI to estimate intestine perfusion after different durations of ischemia is viable using a porcine model of mesenteric ischemia. Even small differences in perfusion can be reliably determined by ICG-FI. Thus, ICG-FI is an encouraging method to evaluate intestine perfusion intraoperatively.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Real time ICGFI quantification using time to peak, slope of fluorescent intensity, and background subtracted peak fluorescent intensity may predict tissue injury, especially if visual assessment is difficult.
“Real time ICGFI quantification using time to peak, slope of fluorescent intensity, and background subtracted peak fluorescent intensity may predict tissue injury, especially if visual assessment is difficult. 119,171,172”
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 [172]
The Methods (Fluorescent imaging; page unavailable) define slope of fluorescence intensity (SFI) and background-subtracted peak fluorescence intensity (BSFI) as the two quantification parameters. The Discussion (page unavailable) says they help predict tissue damage when visual assessment is difficult. The paper does not identify time to peak as a parameter used for that purpose. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHyperintensity due to capillary leakage and the resulting pooling of ICG in the tissue may lead to misinterpretation.
“Hyperintensity due to capillary leakage and the resulting pooling of ICG in the tissue may lead to misinterpretation.”
Already injured tissue can be estimated as optimally perfused by visual evaluation alone.
“Already injured tissue can be estimated as optimally perfused by visual evaluation alone. 172,176”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Intestinal Mucosal Lesion in Low-Flow States
Chiu, C.-J. (1970) · Archives of Surgery · doi:10.1001/archsurg.1970.01340280030009 · Cited by 1,809 · see citing works
Real‐time identification of liver cancers by using indocyanine green fluorescent imaging
Ishizawa, T., Fukushima, N., Shibahara, J., Masuda, K., Tamura, S., Aoki, T., Hasegawa, K., Beck, Y., Fukayama, M., & Kokudo, N. (2009) · Cancer · doi:10.1002/cncr.24291 · Cited by 857 · see citing works
Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins
Björck, M., Koelemay, M., Acosta, S., Bastos Goncalves, F., Kölbel, T., Kolkman, J. J., Lees, T., Lefevre, J. H., Menyhei, G., Oderich, G., et al. (2017) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2017.01.010 · Cited by 658 · see citing works
Acute Mesenteric Ischemia: The Challenge of Gastroenterology
Yasuhara, H. (2005) · Surgery Today · doi:10.1007/s00595-004-2924-0 · Cited by 301 · see citing works
Intestinal ischemia/reperfusion: microcirculatory pathology and functional consequences
Vollmar, B., & Menger, M. D. (2010) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-010-0727-x · Cited by 268 · see citing works
Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review
Kassahun, W. T., Schulz, T., Richter, O., & Hauss, J. (2008) · Langenbeck's Archives of Surgery · doi:10.1007/s00423-007-0263-5 · Cited by 262 · see citing works
Modern treatment of acute mesenteric ischaemia
Acosta, S., & Björck, M. (2013) · British journal of surgery · doi:10.1002/bjs.9330 · Cited by 183 · see citing works
Enhanced-Reality Video Fluorescence: A Real-Time Assessment of Intestinal Viability
Diana, M., Noll, E., Diemunsch, P., Dallemagne, B., Benahmed, M. A., Agnus, V., Soler, L., Barry, B., Namer, I. J., Demartines, N., et al. (2014) · Annals of Surgery · doi:10.1097/sla.0b013e31828d4ab3 · Cited by 168 · see citing works
Quinn, A. D. (1993) · Critical Care Nursing Clinics of North America · doi:10.1016/s0899-5885(18)30596-3 · Cited by 156 · see citing works
Diana, M., Agnus, V., Halvax, P., Liu, Y. Y., Dallemagne, B., Schlagowski, A.-I., Gény, B., Diemunsch, P. A., Lindner, V., & Marescaux, J. (2015) · British journal of surgery · doi:10.1002/bjs.9725 · Cited by 130 · see citing works
Mucosal lesions in the human small intestine in shock.
Haglund, U., Hultén, L., Åhrén, C., & Lundgren, O. (1975) · Gut · doi:10.1136/gut.16.12.979 · Cited by 123 · see citing works
An intraoperative fluorescent imaging system in organ transplantation
Sekijima, M., Tojimbara, T., Sato, S., Nakamura, M., Kawase, T., Kai, K., Urashima, Y., Nakajima, I., FUCHINOUE, S., & Teraoka, S. (2004) · Transplantation Proceedings · doi:10.1016/j.transproceed.2004.09.001 · Cited by 104 · see citing works
Chatterjee, A., Krishnan, N. M., Vliet, M. M. V., Powell, S. G., Rosen, J. M., & Ridgway, E. B. (2013) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e31828659f4 · Cited by 89 · see citing works
Detter, C., Wipper, S. H., Russ, D., Iffland, A., Burdorf, L., Thein, E., Wegscheider, K., Reichenspurner, H. C., & Reichart, B. (2007) · Circulation · doi:10.1161/circulationaha.106.655936 · Cited by 82 · see citing works
Self-citationReal-Time Simultaneous Near-Infrared Fluorescence Imaging of Bile Duct and Arterial Anatomy
Ashitate, Y., Stockdale, A., Choi, H. S., Laurence, R. G., & Frangioni, J. V. (2011) · Journal of Surgical Research · doi:10.1016/j.jss.2011.06.027 · Cited by 81 · see citing works
Intestinal ischemia: current treatment concepts
Renner, P., Kienle, K., Dahlke, M. H., Heiß, P., Pfister, K., Stroszczynski, C., Piso, P., & Schlitt, H. J. (2010) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-010-0726-y · Cited by 72 · see citing works
Matsui, A., Winer, J. H., Laurence, R. G., & Frangioni, J. V. (2011) · British Journal of Surgery · doi:10.1002/bjs.7698 · Cited by 69 · see citing works
(1993) · PubMed · Cited by 65 · see citing works
Indications and procedures for second-look surgery in acute mesenteric ischemia
Meng, X., Liu, L., & Jiang, H. (2010) · Surgery Today · doi:10.1007/s00595-009-4140-4 · Cited by 62 · see citing works
Mizuno, S., & Isaji, S. (2010) · American Journal of Transplantation · doi:10.1111/j.1600-6143.2010.03288.x · Cited by 60 · see citing works
Die akute mesenteriale Ischämie: Resektion oder Rekonstruktion?
Eckstein, H.-H. (2003) · Der Chirurg · doi:10.1007/s00104-003-0630-x · Cited by 54 · see citing works
Iinuma, Y., Hirayama, Y., Yokoyama, N., Otani, T., Nitta, K., Hashidate, H., Yoshida, M., Iida, H., Masui, D., & Manabe, S. (2013) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2013.03.067 · Cited by 50 · see citing works
Debus, E. S., Müller‐Hülsbeck, S., Kölbel, T., & Larena-Avellaneda, A. A. (2011) · International Journal of Colorectal Disease · doi:10.1007/s00384-011-1196-6 · Cited by 50 · see citing works
Self-citationToens, C., Krones, C. J., Blum, U., Fernandez, V., Grommes, J., Hoelzl, F., Stumpf, M., Klinge, U., & Schumpèlick, V. (2005) · International Journal of Colorectal Disease · doi:10.1007/s00384-005-0017-1 · Cited by 45 · see citing works
Nitori, N., Deguchi, T., Kubota, K., Yoshida, M., Kato, A., Kojima, M., Kadomura, T., Okada, A., Okamura, J., Kobayashi, M., et al. (2013) · Surgery Today · doi:10.1007/s00595-013-0503-y · Cited by 43 · see citing works
Fluorescence Angiography in the Assessment of Flap Perfusion and Vitality
Yeoh, M. S., Kim, D. D., & Ghali, G. E. (2013) · Oral and Maxillofacial Surgery Clinics of North America · doi:10.1016/j.coms.2012.11.004 · Cited by 35 · see citing works
Ischemic and injured bowel evaluation by Fluorescence imaging
Nowak, K., Sandra‐Petrescu, F., Post, S., & Horisberger, K. (2015) · Colorectal Disease · doi:10.1111/codi.13032 · Cited by 26 · see citing works
Behrendt, F. F., Tolba, R. H., Overhaus, M., Hirner, A., Minor, T., & Kalff, J. C. (2004) · European Surgical Research · doi:10.1159/000078855 · Cited by 23 · see citing works
Ryu, S., Yoshida, M., Ohdaira, H., Tsutsui, N., Suzuki, N., Ito, E., Nakajima, K., Yanagisawa, S., Kitajima, M., & Suzuki, Y. (2016) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2016.04.020 · Cited by 22 · see citing works
Detter, C., Russ, D., Kersten, J. F., Reichenspurner, H. C., & Wipper, S. H. (2017) · International journal of cardiac imaging · doi:10.1007/s10554-017-1212-1 · Cited by 15 · see citing works
Self-citationWipper, S. H., Reiter, B., Russ, D., Hahnel, F., Kersten, J.-F., Kölbel, T., Reichenspurner, H. C., & Detter, C. (2015) · International journal of cardiac imaging · doi:10.1007/s10554-015-0767-y · Cited by 13 · see citing works
Self-citationTranscardiac Endograft Delivery for Endovascular Treatment of the Ascending Aorta
Wipper, S. H., Lohrenz, C., Ahlbrecht, O., Carpenter, S. W., Tsilimparis, N., Kersten, J. F., Detter, C., Debus, E. S., & Kölbel, T. (2015) · Journal of Endovascular Therapy · doi:10.1177/1526602815581160 · Cited by 11 · see citing works
Self-citationValidation of quantitative assessment of indocyanine green fluorescent imaging in a one-vessel model
Duprée, A., Rieß, H. C., von Kroge, P. H., Izbicki, J. R., Debus, E. S., Mann, O., Pinnschmidt, H. O., Russ, D., Detter, C., & Wipper, S. H. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240188 · Cited by 9 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Self-citationKhalaf, M. H., Abdelrahman, H., El-Menyar, A. A., Afifi, I., Kloub, A. G., Al‐Hassani, A., Rizoli, S. B., & Al-Thani, H. A. S. (2024) · Frontiers in Surgery · doi:10.3389/fsurg.2024.1345831 · Cited by 12 · see citing works
Studier‐Fischer, A., Schwab, F. M., Rees, M., Seidlitz, S., Sellner, J., Özdemir, B., Ayala, L. A., Odenthal, J., Knoedler, S. A., Kowalewski, K., et al. (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000706 · Cited by 11 · see citing works
Indocyanine Green-Loaded Mesoporous Silica Nanocomposite for Breast Cancer Imaging
Ma, Q., Xiao, J., Qiu, Z., Huang, H., Yan, D., You, Y., Wang, L., & Guo, X. (2024) · ACS Applied Nano Materials · doi:10.1021/acsanm.4c00980 · Cited by 10 · see citing works
Nwaiwu, C. A., McCulloh, C. J., Skinner, G. C., Shah, S. K., Kim, P. C. W., Schwaitzberg, S. D., & Wilson, E. B. (2023) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-023-05855-x · Cited by 6 · see citing works
Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature
Ma, T., Zhao, H., Zhang, Q., & Zhang, P. (2024) · Obesity Facts · doi:10.1159/000536359 · Cited by 5 · see citing works
Pfennigs, A. M., Besendörfer, M., Diez, S., & Reingruber, B. (2025) · Frontiers in Pediatrics · doi:10.3389/fped.2025.1641794 · Cited by 4 · see citing works
Kluckner, M., von Kroge, P. H., Duprée, A., Wippel, D., Schönherr, L., Gruber, L. N., Enzmann, F., & Wipper, S. H. (2026) · Scientific Reports · doi:10.1038/s41598-026-47505-7 · Cited by 1 · see citing works
Self-citationAndersen, F. T., Petersen, J., Kaspersen, A. E., Pedersen, M. V., Singer, G., Madsen, M. H. A., Lund, M. A. V., Hasenkam, J. M., & Lading, T. (2025) · Surgical Endoscopy · doi:10.1007/s00464-025-11905-z · Cited by 1 · see citing works
Fabbri, N., Pesce, A., Raimondi, E., Virgilio, F. D., Iroatulam, A. J. N., & Feo, C. V. (2024) · Surgery · doi:10.1016/j.surg.2024.06.030 · Cited by 1 · see citing works
Fluorescent Imaging in Visceral Surgery: Current Opportunities and Future Perspectives
von Kroge, P. H., & Duprée, A. (2023) · Visceral Medicine · doi:10.1159/000530362
Self-citationICG-Fluoreszenz und Enhanced Imaging
Nowak, K. (2024) · Springer eBooks · doi:10.1007/978-3-662-67852-7_6
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
Application of Fluorescence Angiography Using Indocyanine Green: Experimental and Clinical Studies
Lelyavina, Т. А., Kornyushin, O. V., Shemilov, R. R., Masley, V. V., Sonin, D. L., Papayan, G. V., Данилов, И. Н., & Galagudza, M. M. (2025) · Regional blood circulation and microcirculation · doi:10.24884/1682-6655-2025-24-3-4-12
Kim, H. H., Ning, B., Cha, R. J., & Yang, K. M. (2025) · Journal of Biophotonics · doi:10.1002/jbio.202500453
Wang, J., Xiong, J., Cao, W., Ma, J., & Zhang, P. (2026) · Dyes and Pigments · doi:10.1016/j.dyepig.2026.114114
Puente, A., Croceri, R., Medina, P. J., Mihura, M., & Pirchi, D. E. (2026) · International Journal of Surgery Case Reports · doi:10.1097/rc9.0000000000000805
- Authors
- Duprée, A., Rieß, H., von Kroge, P. H., Izbicki, J. R., Debus, E. S., Mann, O., Pinnschmidt, H. O., Russ, D., Detter, C., & Wipper, S. H.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Universität Ulm (DE)
- Corresponding author
- Duprée, Anna
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-07-20
- Volume
- 16
- Issue
- 7
- Pages
- e0254144
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8291700
- OpenAlex
- W2885315511
- Cited by
- 17
- References
- 33
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 3
- FWCI
- 1.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Optical Imaging and Spectroscopy Techniques
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Keywords
- mesenteric ischemia, indocyanine green, fluorescence imaging, intestinal perfusion, intraoperative assessment, porcine model, mesenteric artery occlusion, reperfusion, capillary leak syndrome, ischemic time
- MeSH terms
- Animals, Coloring Agents, Female, Fluorescence, Indocyanine Green, Intestines, Ischemia, Male, Perfusion, Swine, Models, Animal, Optical Imaging, Mesenteric Ischemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
