scholarly journals Use of ICG videoangiography and FLOW 800 analysis to identify the patient-specific venous circulation and predict the effect of venous sacrifice: a retrospective study of 172 patients

2018 ◽  
Vol 45 (1) ◽  
pp. E7 ◽  
Author(s):  
Francesco Acerbi ◽  
Ignazio G. Vetrano ◽  
Tommaso Sattin ◽  
Jacopo Falco ◽  
Camilla de Laurentis ◽  
...  
Keyword(s):  
Flow Direction ◽  
Flow Characteristics ◽  
Venous Drainage ◽  
Extent Of Resection ◽  
Patient Specific ◽  
Drainage Pattern ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Venous Circulation ◽  
Flow 800

OBJECTIVEThe best management of veins encountered during the neurosurgical approach is still a matter of debate. Even if venous sacrifice were to lead to devastating consequences, under certain circumstances, it might prove to be desirable, enlarging the surgical field or increasing the extent of resection in tumor surgery. In this study, the authors present a large series of patients with vascular or oncological entities, in which they used indocyanine green videoangiography (ICG-VA) with FLOW 800 analysis to study the patient-specific venous flow characteristics and the management workflow in cases in which a venous sacrifice was necessary.METHODSBetween May 2011 and December 2017, 1972 patients were admitted to the authors’ division for tumor and/or neurovascular surgery. They retrospectively reviewed all cases in which ICG-VA and FLOW 800 were used intraoperatively with a specific target in the venous angiographic phase or for the management of venous sacrifice, and whose surgical videos and FLOW 800 analysis were available.RESULTSA total of 296 ICG-VA and FLOW 800 studies were performed intraoperatively. In all cases, the venous structures were clearly identifiable and were described according to the flow direction and speed. The authors therefore defined different patterns of presentation: arterialized veins, thrombosed veins, fast-draining veins with anterograde flow, slow-draining veins with anterograde flow, and slow-draining veins with retrograde flow. In 16 cases we also performed a temporary clipping test to predict the effect of the venous sacrifice by the identification of potential collateral circulation.CONCLUSIONSICG-VA and FLOW 800 analysis can provide complete and real-time intraoperative information regarding patient-specific venous drainage pattern and can guide the decision-making process regarding venous sacrifice, with a possible impact on reduction of surgical complications.

Venous sacrifice in neurosurgery: new insights from venous indocyanine green videoangiography

2011 ◽  
Vol 115 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Paolo Ferroli ◽  
Francesco Acerbi ◽  
Giovanni Tringali ◽  
Erminia Albanese ◽  
Morgan Broggi ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Collateral Circulation ◽  
Flow Direction ◽  
Flow Dynamics ◽  
Neurosurgical Procedures ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Specific Test ◽  
Time Flow ◽  
Anastomotic Circulation

Object The purpose of this paper is to evaluate whether venous indocyanine green (ICG) videoangiography has any potential for predicting the presence of a safe collateral circulation for veins that are at risk for intentional or unintentional damage during surgery. Methods The authors performed venous ICG videoangiography during 153 consecutive neurosurgical procedures. On those occasions in which a venous sacrifice occurred during surgery, whether that sacrifice was preplanned (intended) or unintended, venous ICG videoangiography was repeated so as to allow us to study the effect of venous sacrifice. A specific test to predict the presence of venous collateral circulation was also applied in 8 of these cases. Results Venous ICG videoangiography allowed for an intraoperative real-time flow assessment of the exposed veins with excellent image quality and resolution in all cases. The veins observed in this study were found to be extremely different with respect to flow dynamics and could be divided in 3 groups: 1) arterialized veins; 2) fast-draining veins with uniform filling and clear flow direction; and 3) slow-draining veins with nonuniform filling. Temporary clipping was found to be a simple and reversible way to test for the presence of potential anastomotic circulation. Conclusions Venous ICG videoangiography is able to reveal substantial variability in the venous flow dynamics. “Slow veins,” when they are tributaries of bridging veins, might hide a potential for anastomotic circulation that deserve further investigation.

Importance of collateral venous circulation on indocyanine green videoangiography in intracranial meningioma resection: direct evidence for venous compression theory in peritumoral edema formation

2020 ◽  
Vol 132 (6) ◽  
pp. 1715-1723
Author(s):  
Ju-Hwi Kim ◽  
Kyung-Sub Moon ◽  
Ji-Ho Jung ◽  
Woo-Youl Jang ◽  
Tae-Young Jung ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Standard Dose ◽  
Tumor Resection ◽  
Intracranial Meningioma ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Excitation Light ◽  
Venous Circulation ◽  
Flow Restoration ◽  
Venous Collaterals

OBJECTIVEIndocyanine green videoangiography (ICGVA) has been used in many neurosurgical operations, including vascular and brain tumor fields. In this study, the authors applied ICGVA to intracranial meningioma surgery and evaluated it usefulness with attention to collateral venous flow.METHODSForty-two patients with intracranial meningioma who underwent ICGVA during microsurgical resection were retrospectively analyzed. For ICGVA, the ICG was injected intravenously at the standard dose of 12.5 mg before and/or after tumor resection. Intravascular fluorescence from blood vessels was imaged through a microscope with a special filter and infrared excitation light to illuminate the operating field. The authors assessed the benefits of ICGVA and analyzed its findings with preoperative radiological findings on MRI.RESULTSICGVA allowed real-time assessment of the patency and flow direction in very small peritumoral vessels in all cases. A safe dural incision could also be done based on information from ICGVA. The collateral venous channel due to venous obstruction of tumoral compression was found in 10 cases, and venous flow restoration after tumor resection was observed promptly after tumor resection in 4 cases. Peritumoral brain edema (PTBE) was observed on preoperative T2-weighted MRI in 19 patients. The presence of collateral venous circulation or flow restoration was significantly related to PTBE formation in multivariate analysis (p = 0.001; HR 0.027, 95% CI 0.003–0.242).CONCLUSIONSICGVA, an excellent method for monitoring blood flow during meningioma resection, provides valuable information as to the presence of venous collaterals and flow restoration. Furthermore, the fact that the presence of venous collaterals was found to be associated with PTBE may directly support the venous theory as the pathogenesis of PTBE formation.

scholarly journals Role of time-resolved-CTA in intracranial arteriovenous malformation evaluation at 128-slice CT in comparison with digital subtraction angiography

2018 ◽  
Vol 31 (3) ◽  
pp. 235-243 ◽  
Author(s):  
Rupinder Singh ◽  
Vivek Gupta ◽  
Chirag Ahuja ◽  
Ajay Kumar ◽  
Kanchan K Mukherjee ◽  
...  
Keyword(s):  
Flow Characteristics ◽  
Venous Drainage ◽  
External Carotid Artery ◽  
External Carotid ◽  
Drainage Pattern ◽  
Outflow Obstruction ◽  
Time Resolved ◽  
Venous Outflow Obstruction ◽  
Arterial Feeder ◽  
Age Range

Introduction The present study aimed to evaluate the accuracy of time-resolved-computed tomographic angiography (TR-CTA) on a 128-slice CT scanner vis-à-vis cerebral digital subtraction angiography (DSA) in defining the morphological and haemodynamic characteristics of cerebral arteriovenous malformation (AVM). Methods Twenty-one patients (age range 10–46, mean 24.8 years) with clinical suspicion of AVM and three patients (age range 23–35, mean 24.3 years) with diagnosed AVM who were on follow-up underwent DSA and TR-CTA, on average 1.5 days apart. Three independent neuroradiologists analysed both studies in a blinded fashion based on the following parameters: AVM location, arterial feeder territories, venous drainage pattern, nidus flow characteristics, venous outflow obstruction, arterial feeder enlargement, external carotid artery feeder, location of aneurysm if any, leptomeningeal and transdural recruitment, neoangiogenesis, and pseudophlebitic pattern. Results The TR-CTA correctly demonstrated AVM in all 21 positive cases. It concordantly detected location (21/21), venous drainage pattern (21/21), nidus flow characteristics (21/21), and the venous outflow obstruction (9/9). However, discordance was seen in the demonstration of the arterial feeder (2/45) ( p = 0.49), arterial enlargement (13/17) ( p = 0.103), external carotid artery feeder (0/1), aneurysmal location (3/5) ( p = 0.40), leptomeningeal recruitment (1/3) ( p = 0.40), neoangiogenesis (0/4) ( p = 0.028) and in the pseudophlebitic pattern (2/5) ( p = 0.167) demonstration. Conclusions The results suggest that TR-CTA can provide the important features of cerebral AVM which are required in patient management.

scholarly journals Differences of the midline-crossing venous drainage pattern in supraumbilical and infraumbilical regions: Angiographic study using fresh cadavers

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242214
Author(s):  
Seong Oh Park ◽  
Hak Chang ◽  
Nobuaki Imanishi
Keyword(s):  
Perforator Flap ◽  
Venous Drainage ◽  
Drainage Pattern ◽  
Venous Anatomy ◽  
Predisposing Factor ◽  
Venous Flow ◽  
Additional Information ◽  
Midline Crossing ◽  
Deep Inferior Epigastric Perforator ◽  
The Mean

Current clinical and anatomical studies show that the venous problem associated with the deep inferior epigastric perforator flap results from poor midline-crossing. We examined the venous anatomy of the infraumbilical midline area and the dynamic venous flow of the deep inferior epigastric perforator flap in nine fresh cadavers. All nine abdominal specimens were harvested between the subcostal margin and the groin crease. Two specimens were used to analyze the abdominal venous anatomy, one of which was divided into two hemi-abdominal specimens. The remaining seven specimens were harvested as deep inferior epigastric perforator flaps with one major paraumbilical perforator. Venous cannulation and serial angiographic agent injection were performed in several conditions. Each specimen was radiographed using a soft X-ray system. For additional information, computed tomography (CT) angiography-visualized superficial inferior epigastric veins (SIEVs) and the supraumbilical branch were analyzed. We noted that the venous drainage between the bilateral SIEVs was easier to configure in the supraumbilical area than in the infraumbilical area. Only one to two short polygonal venous networks connect the bilateral superficial inferior epigastric veins in the supraumbilical area; however, long and multiple polygonal venous networks connect the bilateral superficial inferior epigastric veins in the infraumbilical area, which could be a predisposing factor for venous congestion. The mean distance from the umbilicus upper border to evident supraumbilical midline crossover was 18.39±4.03 mm (range: 10.10–28.49) in CT angiograms. In cadaver specimens, the mean distance was 10.87±4.85 mm (range: 4.6–18.9). Supraumbilical midline crossover was more favorable than infraumbilical midline crossover in venous flow.

Intraoperative Flow Measurement by Microflow Probe During Surgery for Brain Arteriovenous Malformations

2015 ◽  
Vol 11 (2) ◽  
pp. 268-273 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Oriela Rustemi ◽  
Renato Scienza
Keyword(s):  
Flow Measurement ◽  
Flow Direction ◽  
Venous Drainage ◽  
Measurement Procedure ◽  
Indocyanine Green Videoangiography ◽  
Vessel Injury ◽  
Microsurgical Resection ◽  
Brain Avms ◽  
The Impact ◽  
Quantitative Flow

Abstract BACKGROUND Intraoperative quantitative flow measurement by a microvascular ultrasonic flow probe is an established methodology in aneurysm surgery. OBJECTIVE To test the present flow measurement procedure in brain arteriovenous malformation (AVM) surgery. METHODS Data from 25 patients with brain AVMs who consecutively underwent microsurgical resection with the assistance of flow measurement by a microflow probe were retrospectively analyzed. Flowmetry was performed on arterial feeders, potentially transit arteries, and venous drainage of AVM in different phases of resection. RESULTS A quantitative flow measurement was performed 203 times on 92 vessels. Flowmetry was able to define the flow direction of AVM vessels in all cases, thereby discriminating between arterial feeders and venous drainages, both superficially and deeply located. During AVM dissection, flowmetry identified a transit artery in 12% of cases by detecting a flow drop between 2 points of the same vessel. At the final stage of resection, a residual nidus, potentially missed at surgical dissection, was detected when the flow value of venous drainage was greater than 4 mL/min (20% of patients). Pre-resection microflow probe measurements were concordant with indocyanine green videoangiography data on AVM angioarchitecture in all cases. No microflow probe–induced AVM vessel injury was reported. Complete AVM resection was achieved in all cases with a low morbidity (modified Rankin Scale score ⩽1). CONCLUSION Multistage intraoperative quantitative flow measurement proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of AVM resection. Further studies are needed to assess the impact of this approach on AVM patient outcomes.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

Evaluation of the venous drainage pattern of the splenic flexure by preoperative three‐dimensional computed tomography

2018 ◽  
Vol 12 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Akira Arimoto ◽  
Takeru Matsuda ◽  
Hiroshi Hasegawa ◽  
Kimihiro Yamashita ◽  
Tetsu Nakamura ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Splenic Flexure ◽  
Three Dimensional ◽  
Venous Drainage ◽  
Drainage Pattern

Role of Plaque Morphology in Altering the Flow Characteristics in Diseased Coronary Artery

2012 ◽  
Author(s):  
Carlos Moreno ◽  
Kiran Bhaganagar
Keyword(s):  
Coronary Artery ◽  
Nonlinear Response ◽  
Flow Characteristics ◽  
Proximal Region ◽  
Patient Specific ◽  
Plaque Morphology ◽  
Mean Velocity ◽  
Peak Location ◽  
The Mean

Patient specific simulations of a single patient based on an accurate representation of the plaque in a diseased coronary artery with 35% stenosis are performed to understand the effect of inlet forcing frequency and amplitude on the wall shear stress (WSS). Numerical simulations are performed with unsteady flow conditions in a laminar regime. The results have revealed that at low amplitudes, WSS is insensitive to forcing frequency and is it in phase with Q. The maximum WSS is observed at the proximal region of the stenosis, and WSS has highest negative values at the peak location of the stenosis. For higher pulsatile amplitude (a > 1.0), WSS exhibits a strong sensitivity with forcing frequencies. At higher forcing frequency the WSS exhibits nonlinear response to the inlet forcing frequency. Furthermore, significant differences in the mean velocity profile are observed during maximum and minimum volumetric flow rates.

Numerical Simulation on Heat Transfer and Fluid Flow Characteristics of Arrays With Nonuniform Plate Length Positioned Obliquely to the Flow Direction

1998 ◽  
Vol 120 (4) ◽  
pp. 991-998 ◽  
Author(s):  
L. B. Wang ◽  
G. D. Jiang ◽  
W. Q. Tao ◽  
H. Ozoe
Keyword(s):  
Heat Transfer ◽  
Pressure Drop ◽  
Flow Direction ◽  
Flow Characteristics ◽  
Numerical Results ◽  
The Body ◽  
Number Range ◽  
Plate Length ◽  
Nonuniform Plate ◽  
Short Plate

The periodically fully developed laminar heat transfer and pressure drop of arrays with nonuniform plate length aligned at an angle (25 deg) to air direction have been investigated by numerical analysis in the Reynolds number range of 50–1700. The body-fitted coordinate system generated by the multisurface method was adopted to retain the corresponding periodic relation of the lines in physical and computational domains. The computations were carried out just in one cycle. Numerical results show that both the heat transfer and pressure drop increase with the increase in the length ratio of the long plate to the short plate, and decrease with the decrease in the ratio of transverse pitch to the longitudinal pitch. The numerical results exhibit good agreement with available experimental data.

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