Abstract
Purpose
Although useful for visualizing blood flow during revascularization surgery, the permeability of near-infrared fluorescence (NIR) angiography using indocyanine green (ICG) does not allow for vessel stenosis visualization. We hypothesized that changes in ICG fluorescence intensity reflect vessel stenosis, and evaluated the influence of stenosis on blood flow by ex vivo experimentation.
Methods
The vessel stenosis model comprised a silicon tube, a graft occluder, and artificial blood. During near-infrared angiography, the fluorescense intensity was calculated during pre- and post-stenosis of an artificial circuit, using a NIR angiography. We measured the maximum fluorescence intensity and the time to maximum fluorescence intensity.
Results
Severe stenosis (≥75%) attenuated the increase in ICG fluorescence intensity in the tube significantly, pre- and post-stenosis. The time to maximum fluorescence intensity did not differ between sites pre- and post-stenosis, irrespective of stenosis severity.
Conclusion
Stenosis affected the ICG fluorescence intensity through the vessel. Thus, quantitative analysis using NIR angiography may detect severe vessel stenosis (≥75%), and the extinction curve of indocyanine fluorescence intensity may support the evaluation of blood flow. The absence of differences in the time to maximum fluorescence intensity for degrees of stenosis might suggest a limitation of previous conventional qualitative assessments.
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References
Tomoaki S, Tohru A. The current status of multi-arterial off-pump coronary artery bypass grafting. Surg Today. 2016;46(1):1–12.
Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004;350(1):21–8.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85.
Rubens FD, Ruel M, Fremes SE. A new and simplified method for coronary and graft imaging during CABG. Heart Surg Forum. 2002;5(2):141–4.
Cherrick GR, Stein SW, Leevy CM, Davidson CS. Indocyanine green: observations on its physical properties, plasma decay, and hepatic extraction. J Clin Invest. 1960;39:592–600.
Reuthebuch O, Haussler A, Genoni M, Tavakoli R, Odavic D, Kadner A, et al. Novadaq SPY: intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest. 2004;125(2):418–24.
Taggart DP, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswami L, Pigott DW. Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg. 2003;75(3):870–3.
Yamamoto M, Sasaguri S, Sato T. Assessing intraoperative blood flow in cardiovascular surgery. Surg Today. 2011;41(11):1467–74.
Yamamoto M, Orihashi K, Nishimori H, Handa T, Kondo N, Fukutomi T, et al. Efficacy of intraoperative HyperEye Medical System angiography for coronary artery bypass grafting. Surg Today. 2015;45(8):966–72.
Yamamoto M, Orihashi K, Nishimori H, Wariishi S, Fukutomi T, Kondo N, et al. Indocyanine green angiography for intra-operative assessment in vascular surgery. Eur J Vasc Endovasc Surg. 2012;43(4):426–32.
Handa T, Katare RG, Sasaguri S, Sato T. Preliminary experience for the evaluation of the intraoperative graft patency with real color charge-coupled device camera system: an advanced device for simultaneous capturing of color and near-infrared images during coronary artery bypass graft. Interact Cardio Vasc Thorac Surg. 2009;9(2):150–4.
Yamamoto M, Nishimori H, Handa T, Fukutomi T, Kihara K, Tashiro M et al. Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting. Surg Today. 2016. doi:10.1007/s00595-016-1369-6
Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol. 1978;23(1):159–63.
Detter C, Wipper S, Russ D, Iffland A, Burdorf L, Thein E, et al. Fluorescent cardiac imaging: a novel intraoperative method for quantitative assessment of myocardial perfusion during graded coronary artery stenosis. Circulation. 2007;116(9):1007–14.
Ferguson TB Jr, Chen C, Babb JD, Efird JT, Daggubati R, Cahill JM. Fractional flow reserve-guided coronary artery bypass grafting: can intraoperative physiologic imaging guide decision making? J Thorac Cardiovasc Surg. 2013;146(4):824–35.
Acknowledgements
This work was supported by JSPS KAKENHI (Grant No. 20437718) and The Fujita Memorial Fund for Medical Research. We thank Clinical Engineers Tomotaka Takesima, Kazuhiro Imakubo, and Yuto Sasaki for their technical support with the manipulation of NIR angiography.
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Masaki Yamamoto and his co-authors have no conflicts of interest.
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Yamamoto, M., Nishimori, H., Fukutomi, T. et al. Influence of vessel stenosis on indocyanine green fluorescence intensity assessed by near-infrared fluorescence angiography. Surg Today 47, 877–882 (2017). https://doi.org/10.1007/s00595-016-1453-y
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DOI: https://doi.org/10.1007/s00595-016-1453-y