Indocyanine green videoangiography-assisted prediction of flap necrosis in the rat epigastric flap using the flow®800 tool

Microsurgery ◽  
2016 ◽  
Vol 37 (3) ◽  
pp. 235-242 ◽  
Author(s):  
Thomas Mücke ◽  
Andreas M. Fichter ◽  
Leonard H. Schmidt ◽  
David A. Mitchell ◽  
Klaus-Dietrich Wolff ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Flap Necrosis ◽  
Indocyanine Green Videoangiography ◽  
Epigastric Flap

scholarly journals Prediction of Flap Necrosis by Using Indocyanine Green Videoangiography in Cases of Venous Occlusion in the Epigastric Flap Model of the Rat

2018 ◽  
Vol 03 (02) ◽  
pp. e62-e69
Author(s):  
Lucas Ritschl ◽  
Leonard Schmidt ◽  
Andreas Fichter ◽  
Alexander Hapfelmeier ◽  
Anastasios Kanatas ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Venous Occlusion ◽  
Venous Congestion ◽  
Venous Stasis ◽  
Head And Neck Reconstruction ◽  
Flap Necrosis ◽  
Flow Measurements ◽  
Doppler Flowmetry ◽  
Flow 800 ◽  
Epigastric Flap

Background A compromised free flap perfusion attributable to vascular occlusion requires immediate operative correction. Indocyanine green (ICG) videoangiography may reduce the risk of partial skin flap necrosis in high-risk free flaps in patients undergoing head and neck reconstruction. The purpose of this study was to determine the role of ICG in cases of venous congestion in a rat model. Methods A standardized epigastric flap was raised and repositioned in 35 rats. Full venous occlusion of the draining superficial inferior epigastric vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements including simultaneous laser-Doppler flowmetry and tissue spectrophotometry (oxygen-to-see [O2C]) and ICG videoangiography with the FLOW 800 tool were performed before flap raising, after temporary venous stasis, and after clinical monitoring for 1 week. The Youden index computed from the receiver operating characteristic curve was used to define an optimal cutoff value for necrosis prediction after 4 and 6 hours of stasis. Results The ICG videoangiography with the FLOW 800 tool was found to be superior to O2C in the prediction of flap necrosis. The accuracy of prediction was moderate after an interval of 4 hours of stasis (area under the curve [AUC] = 0.661; 95% confidence interval [CI]: 0.489–0.834) and good after 6 hours of stasis (AUC = 0.787; 95% CI: 0.65–0.915). Conclusions The O2C does not reliably predict tissue necrosis in cases of venous congestion. ICG videoangiography is a valuable tool that can predict clinical outcome and provide guidance on whether to salvage a congested flap.

scholarly journals Can the Efficacy of Indocyanine Green Videoangiography in Cerebral Arterio-Venous Malformations Surgery Be Further Improved?

Neurosurgery ◽  
2014 ◽  
Vol 75 (6) ◽  
pp. E732-E734 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Renato Scienza ◽  
Oriela Rustemi ◽  
Giorgio Gioffré
Keyword(s):  
Indocyanine Green ◽  
Venous Malformations ◽  
Indocyanine Green Videoangiography

The “Squeezing Maneuver” in Microsurgical Clipping of Intracranial Aneurysms Assisted by Indocyanine Green Videoangiography

2014 ◽  
Vol 10 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Oriela Rustemi ◽  
Marta Rossetto ◽  
Giorgio Gioffrè ◽  
Marina Munari ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Intracranial Aneurysms ◽  
Aneurysm Surgery ◽  
Radiological Findings ◽  
Indocyanine Green Videoangiography ◽  
Microsurgical Clipping ◽  
Intraoperative Detection ◽  
Small Series ◽  
Vessel Patency ◽  
Derived Data

Abstract BACKGROUND: Indocyanine green videoangiography (ICGV) is becoming routine in intracranial aneurysm surgery to assess intraoperatively both sac obliteration and vessel patency after clipping. However, ICGV-derived data have been reported to be misleading at times. We recently noted that a simple intraoperative maneuver, the “squeezing maneuver,” allows the detection of deceptive ICGV data on aneurysm exclusion and allows potential clip repositioning. The squeezing maneuver is based on a gentle pinch of the dome of a clipped aneurysm when ICGV documents its apparent exclusion. OBJECTIVE: To present the surgical findings and the clinical outcome of this squeezing maneuver. METHODS: Data from 23 consecutive patients affected by intracranial aneurysms who underwent the squeezing maneuver were analyzed retrospectively. The clip was repositioned in all cases when the dyeing of the sac was visualized after the maneuver. RESULTS: In 22% of patients, after an initial ICGV showing the aneurysm exclusion after clipping, the squeezing maneuver caused the prompt dyeing of the sac; in all cases, the clip was consequently repositioned. A calcification/atheroma of the wall/neck was predictive of a positive maneuver (P = .001). The aneurysm exclusion rate at postoperative radiological findings was 100%. CONCLUSION: With the limits of our small series, the squeezing maneuver appears helpful in the intraoperative detection of misleading ICGV data, mostly when dealing with aneurysms with atheromatic and calcified walls.

Indocyanine Green Videoangiography “In Negative”: Definition and Usefulness in Intracranial Dural Arteriovenous Fistulae

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons86-ons92 ◽  
Author(s):  
Juan Antonio Julián ◽  
Pablo Miranda Lloret ◽  
Fernando Aparici Robles ◽  
Andrés Beltrán Giner ◽  
Carlos Botella Asunción
Keyword(s):  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Simple Procedure ◽  
Vascular Pathology ◽  
Digital Subtraction ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

Abstract BACKGROUND: Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. OBJECTIVE: Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. METHODS: In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. RESULTS: In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. CONCLUSION: IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

scholarly journals Safe and accurate sylvian dissection with the use of indocyanine green videoangiography

2016 ◽  
Vol 7 (15) ◽  
pp. 427 ◽  
Author(s):  
Hisashi Kubota ◽  
Yasuhiro Sanada ◽  
Kazuhiro Nagatsuka ◽  
Hiromasa Yoshioka ◽  
Michihiro Iwakura ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Videoangiography
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