Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography

Onoda, Shigeki; Azumi, Shogo; Hasegawa, Kazunori; Kimata, Yoshihiro

doi:10.1002/micr.22079

Cited by 64 publications

(68 citation statements)

References 23 publications

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“…Here, we report the use of near-infrared (NIR) laparoscopic technology to confirm and document viability and perfusion of digestive anastomoses by means of an on-table, real-time fluorophoric [indocyanine green (ICG)] angiogram in a series of consecutive patients who underwent laparoscopic colorectal resection with primary anastomosis. This builds on the earlier recently published experience in which similar technology was employed endoluminally [7, 8] and within the Da Vinci robot platform [9] and indeed for nongastrointestinal indications [10, 11]. …”

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confidence: 87%

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

et al. 2014

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BackgroundAnastomotic leakage is a devastating complication of colorectal surgery. However, there is no technology indicative of in situ perfusion of a laparoscopic colorectal anastomosis.MethodsWe detail the use of near-infrared (NIR) laparoscopy (PinPoint System, NOVADAQ, Canada) in association with fluorophore [indocyanine green (ICG), 2.5 mg/ml] injection in 30 consecutive patients who underwent elective minimally invasive colorectal resection using the simultaneous appearance of the cecum or distal ileum as positive control.ResultsThe median (range) age of the patients was 64 (40–81) years with a median (range) BMI of 26.7 (20–35.5) kg/m2. Twenty-four patients had left-sided resections (including six low anterior resections) and six had right-sided resections. Of the total, 25 operations were cancer resections and five were for benign disease [either diverticular strictures (n = 3) or Crohn’s disease (n = 2)]. A high-quality intraoperative ICG angiogram was achieved in 29/30 patients. After ICG injection, median (range) time to perfusion fluorescence was 35 (15–45) s. Median (range) added time for the technique was 5 (3–9) min. Anastomotic perfusion was documented as satisfactory in every successful case and encouraged avoidance of defunctioning stomas in three patients with low anastomoses. There were no postoperative anastomotic leaks.ConclusionPerfusion angiography of colorectal anastomosis at the time of their laparoscopic construction is feasible and readily achievable with minimal added intraoperative time. Further work is required to determine optimum sensitivity and threshold levels for assessment of perfusion sufficiency, in particular with regard to anastomotic viability.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-014-3432-y) contains supplementary material, which is available to authorized users.

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confidence: 87%

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

et al. 2014

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“…It is suggested that the surgeons should be collaborating with radiologists to complete the data processing, as well as the synthesis and analysis of the images. In this way, When comparing with other methods that are currently used for detection of perforators, such as Doppler, duplex scan, MRI, DSA, and ICG [11][12][13] (Table 2), there are some clear advantages with MD-CT angiography: It is minimally invasive in nature but reliable and accurate and can display a range of vessels through a 3-dimensional reconstruction model. In addition, the data can be assembled as a 4-dimensional video for the perforators.…”

Section: Discussionmentioning

confidence: 99%

The Value of Multidetector Row Computed Tomography Angiography for Preoperative Planning of Freestyle Pedicled Perforator Flaps

Yang

Wang²,

Ono³

et al. 2016

Annals of Plastic Surgery

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“…The most serious drawback of CTA is that it uses ionizing radiation with the potential increased risk of radiation‐induced carcinogenesis. Other imaging techniques are represented by doppler ultrasound and color duplex ultrasound, which have been used in planning free perforator flaps (Teunis, Heerma van Voss, Kon, & van Maurik, ), and magnetic resonance angiography (Kurlander, Brown, Iglesias, Gulani, & Soltanian, ), or combined techniques (Onoda, Azumi, Hasegawa, & Kimata, ). In particular the intraoperatory Doppler ultrasound could be useful, but it does not allow a preoperative assessment of the individual vascular anatomy.…”

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confidence: 99%

Radiological anatomy of the perforators of the gluteal region: The “radiosome” based anatomy

Vigato

Tiengo

et al. 2017

Microsurgery

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Background The superior (SGA) and the inferior gluteal artery (IGA) perforator flaps are widely used in pressure‐sore repair and in breast reconstruction. The aim was to exhaustively depict the topographical anatomy of the whole system of perforators in the buttock. Methods Eighty lower‐extremity computed tomographic angiography (CTA) of patients (20 males/20 females, mean age 61‐years old, range 38‐81) were considered. The source artery, location, type, and caliber of gluteal perforators were analyzed. The location of perforators was reproduced using a standardized two‐dimensional grid on the coronal plane, centered onto defined bone landmarks. We defined “radiosome” the cutaneous vascular territory of a source artery inferred through the representation of its whole perforator system at the exit point through the deep fascia. Results A mean number of 25.6 ± 5.7 perforators in the gluteal region was observed, distributed as follows: 11.6 ± 4.8(45.2%) from SGA; 7.9 ± 4.5(30.8%) from IGA; 1.5 ± 0.8(5.8%) from fifth lumbar artery; 1.2 ± 0.8(4.7%) from internal pudendal artery; 1.2 ± 1(4.8%) from lateral circumflex femoral artery; 0.3 ± 0.7(1.2%) from circumflex iliac superficial artery. At least one large (internal diameter > 1 mm) SGA septocutaneous perforator was present in 77.5% of patients. Conclusions The gluteal region is vascularized by perforators of multiple source arteries. Septocutaneous perforators of SGA and IGA were planned along a curve drawn from the posterior‐superior border of the iliac crest to the greater trochanter. The lumbar artery perforators are clustered over the apex of the iliac crest; the internal pudendal artery perforators are clustered medially to the ischiatic tuberosity. Contributions can also come from the sacral and superficial circumflex iliac arteries.

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Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography

Abstract: On the basis of the results, selection of the most suitable mode of examination depending on the characteristics of flap is recommended.

Cited by 64 publications

References 23 publications

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery

The Value of Multidetector Row Computed Tomography Angiography for Preoperative Planning of Freestyle Pedicled Perforator Flaps

Radiological anatomy of the perforators of the gluteal region: The “radiosome” based anatomy

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