We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Real-time fluorescence angiography by intra-arterial indocyanine green injection to identify obscure gastrointestinal bleeding territory: proof of concept in the porcine model.
- Authors
Liu, Yu-Yin; Pop, Raoul; Diana, Michele; Kong, Seong-Ho; Lègner, Andras; Beaujeux, Rémy; Marescaux, Jacques; Lègner, Andras; Beaujeux, Rémy
- Abstract
<bold>Background: </bold>Despite intensive preoperative localization workouts, intraoperative localization of the bleeding source in case of obscure gastrointestinal bleeding (OGIB) can be cumbersome and time-consuming. Our aim was to assess the feasibility of image-guided laparoscopic identification of the small bowel loop containing the bleeding source with and without near-infrared angiographic enhancement.<bold>Materials and Methods: </bold>Angiography of superior mesenteric artery (SMA) branches was performed in 11 pigs using a right femoral artery approach, followed by a three-port laparoscopy, using a near-infrared-equipped laparoscope. Two pigs were used to identify the optimal intra-arterial indocyanine green (ICG) dose. Eight pigs were divided into two groups: ICG near-infrared angiography-assisted laparoscopy (n = 4) and fluoroscopic-assisted laparoscopy (n = 4). Finally, in one pig, a novel OGIB model was created and used to evaluate the ICG enhancement pattern in the presence of active bleeding.<bold>Results: </bold>Mean time to identify the fluorescence signal from the small bowel segment fed by the catheterized SMA branch was 13.75 ± 7.8 s, which was statistically significantly shorter than the time required to identify the tip of the catheter by fluoroscopic guidance, i.e., 243.25 ± 107 s (p = 0.02).<bold>Conclusions: </bold>Near-infrared fluorescence angiography using intra-arterial ICG injection provides a fast image-guided intraoperative localization of the small bowel loop fed by the arterial territory identified as bleeding by digital subtraction angiography and could help target the bleeding source during OGIB surgery.
- Subjects
FLUORESCENCE angiography; INDOCYANINE green; GASTROINTESTINAL diseases; PREOPERATIVE care; LAPAROSCOPIC surgery; SUPERIOR mesenteric artery syndrome
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2016, Vol 30, Issue 5, p2143
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-015-4460-y