Evaluation of Patency After Vascular Anastomosis Using Quantitative Evaluation of Visualization Time in Indocyanine...

In vascular reconstructive surgery, intraoperative confirmation of patency is performed by angiography, Doppler, or indocyanine videoangiography, but it is sometimes insufficient.

Using the FLOW 800 system (Carl Zeiss, Oberkochen, Germany), we confirmed patency in a quantitative relative evaluation of the timing of the luminance change of the regions of interest (ROIs) on the donor and recipient.

Thirty-seven patients (58 anastomoses) were divided into 2 groups: those with arteriosclerotic ischemic disease (CI group; n = 23) and those with cerebral aneurysm (AN group; n = 14). Four ROIs were set: the donor, proximal, and distal sides of the recipient middle cerebral artery (MCA) and cortical MCA (control MCA). The half-life for fluorescence intensity was calculated by using the FLOW 800 system. A delay map analysis was also performed.

In the CI group, there were statistically significant differences (P < 0.05) between the donor vessel and control MCA, proximal MCA and MCA control, and distal MCA and control MCA. The investigation with the delay map showed red tones in 20/22 patients in the CI group and in 2/17 patients in the AN group.

In the CI group, the transit time of the donor vessel was shown relatively early as red T. When good patency has been achieved, the FLOW 800 system can be used to confirm patency more reliably, especially in ischemic regions. The unique point of this research is that the patency of anastomotic vessels was evaluated as a quantitative value of its rendering time rather than as a change in fluorescence intensity.