Understanding fluorescence time curves during ileal pouch-anal anastomosis with or without vascular ligation.

Autor: Joosten JJ; Department of Surgery, Amsterdam University Medical Centres (UMC), Academic Medical Centre (AMC), Postbox 22660, 1100 DD, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Slooter MD; Department of Radiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., van den Elzen RM; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bloemen PR; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Laméris W; Department of Surgery, Amsterdam University Medical Centres (UMC), Academic Medical Centre (AMC), Postbox 22660, 1100 DD, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., de Bruin DM; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Biomedical Engineering, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Bemelman WA; Department of Surgery, Amsterdam University Medical Centres (UMC), Academic Medical Centre (AMC), Postbox 22660, 1100 DD, Amsterdam, The Netherlands.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Hompes R; Department of Surgery, Amsterdam University Medical Centres (UMC), Academic Medical Centre (AMC), Postbox 22660, 1100 DD, Amsterdam, The Netherlands. r.hompes@amsterdamumc.nl.; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands. r.hompes@amsterdamumc.nl.; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. r.hompes@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2023 Jul; Vol. 37 (7), pp. 5086-5093. Date of Electronic Publication: 2023 Mar 14.
DOI: 10.1007/s00464-023-09921-y
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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