J.Jpn. Surg. Soc.. 121(1): 39-47, 2020

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Feature topic

APPLICATIONS, INVESTIGATIONS, AND FUTURE OF FLUORESCENT IMAGING IN CARDIOVASCULAR SURGERY

In cardiovascular surgery, indocyanine green (ICG) imaging is used for assessing the flow in vessels and/or tissue perfusion. While repeated assessment in the surgical field is feasible without radiation exposure, imaging is limited by the overlaying tissue due to the poor penetration of fluorescence. In coronary artery bypass grafting, intraoperative assessment of patency or stenosis of the graft is helpful for improving the patency rate. When assessment using transit-time flowmetry occasionally conflicts with that using ICG imaging, investigators have decided in favor of the latter. However, quantitative assessment of ICG imaging has not been adequately established, and automatic analysis of the intensity curve is anticipated. In peripheral arterial disease, ICG imaging is used for assessing bypass surgery grafts. Whereas grafts under the skin cannot be visualized, the patency and stenosis can be assessed at the anastomosis sites. Perfusion of the lower extremities can also be assessed by imaging of the skin and is used for assessing bypass grafts and determining the extent of debridement in cases of ischemic ulcer. In lymphedema, ICG imaging is used for differential diagnosis to rule out edema, assessment of manual lymph drainage, and identifying the optimal site of lymphaticovenous anastomosis as well as assessing the results of anastomosis. The advantages of ICG imaging could be maximized by making the best use of its merits while adopting complementary measures to overcome its limitations.

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