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Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation
BACKGROUND: Intraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impa...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10322949/ https://www.ncbi.nlm.nih.gov/pubmed/36917344 http://dx.doi.org/10.1007/s00464-023-09921-y |
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author | Joosten, J. J. Slooter, M. D. van den Elzen, R. M. Bloemen, P. R. Laméris, W. de Bruin, D. M. Bemelman, W. A. Hompes, R. |
author_facet | Joosten, J. J. Slooter, M. D. van den Elzen, R. M. Bloemen, P. R. Laméris, W. de Bruin, D. M. Bemelman, W. A. Hompes, R. |
author_sort | Joosten, J. J. |
collection | PubMed |
description | BACKGROUND: Intraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impact of vascular ligation. Perfusion parameters were also compared in patients with and without anastomotic leakage (AL). METHODS: All consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T(0), T(max), F(max), slope, Time-to-peak) and outflow (T(90%) and T(80%)). Change of management related to FA findings and AL rates were recorded. RESULTS: Twenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer T(max) in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8–4.4) versus 2.2 (1.3–3.6) in ICA intact patients. CONCLUSION: Quantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-09921-y. |
format | Online Article Text |
id | pubmed-10322949 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-103229492023-07-07 Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation Joosten, J. J. Slooter, M. D. van den Elzen, R. M. Bloemen, P. R. Laméris, W. de Bruin, D. M. Bemelman, W. A. Hompes, R. Surg Endosc Original Article BACKGROUND: Intraoperative indocyanine green fluorescence angiography (ICG-FA) may be of added value during pouch surgery, in particular after vascular ligations as lengthening maneuver. The aim was to determine quantitative perfusion parameters within the efferent/afferent loop and explore the impact of vascular ligation. Perfusion parameters were also compared in patients with and without anastomotic leakage (AL). METHODS: All consenting patients that underwent FA-guided ileal pouch-anal anastomosis (IPAA) between July 2020 and December 2021 were included. After intravenous bolus injection of 0.1 mg/kg ICG, the near-infrared camera (Stryker Aim 1688) registered the fluorescence intensity over time. Quantitative analysis of ICG-FA from standardized regions of interests on the pouch was performed using software. Fluorescence parameters were extracted for inflow (T(0), T(max), F(max), slope, Time-to-peak) and outflow (T(90%) and T(80%)). Change of management related to FA findings and AL rates were recorded. RESULTS: Twenty-one patients were included, three patients (14%) required vascular ligation to obtain additional length, by ligating terminal ileal branches in two and the ileocolic artery (ICA) in one patient. In nine patients the ICA was already ligated during subtotal colectomy. ICG-FA triggered a change of management in 19% of patients (n = 4/21), all of them had impaired vascular supply (ligated ileocolic/ terminal ileal branches). Overall, patients with intact vascular supply had similar perfusion patterns for the afferent and efferent loop. Pouches with ICA ligation had longer T(max) in both afferent as efferent loop than pouches with intact ICA (afferent 51 and efferent 53 versus 41 and 43 s respectively). Mean slope of the efferent loop diminished in ICA ligated patients 1.5(IQR 0.8–4.4) versus 2.2 (1.3–3.6) in ICA intact patients. CONCLUSION: Quantitative analysis of ICG-FA perfusion during IPAA is feasible and reflects the ligation of the supplying vessels. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-023-09921-y. Springer US 2023-03-14 2023 /pmc/articles/PMC10322949/ /pubmed/36917344 http://dx.doi.org/10.1007/s00464-023-09921-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Joosten, J. J. Slooter, M. D. van den Elzen, R. M. Bloemen, P. R. Laméris, W. de Bruin, D. M. Bemelman, W. A. Hompes, R. Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title | Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title_full | Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title_fullStr | Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title_full_unstemmed | Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title_short | Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
title_sort | understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10322949/ https://www.ncbi.nlm.nih.gov/pubmed/36917344 http://dx.doi.org/10.1007/s00464-023-09921-y |
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