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Fluorescence Angiography for Evaluation of Aneurysm Perfusion and Parent Artery Patency in Rat and Rabbit Aneurysm Models
Published on: July 24, 2019
A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG
M Alekseev1,2, E Rybakov1, Y Shelygin1,2
1State Scientific Centre of Coloproctology, Moscow, Russia.
Insights
Indocyanine green (ICG) fluorescence angiography (FA) reduced anastomotic leakage (AL) in low anterior resections. This technique improved surgical outcomes by identifying impaired blood perfusion, particularly in lower colorectal anastomoses.
Area of Science:
- Colorectal surgery
- Surgical oncology
- Medical imaging
Background:
- Anastomotic leakage (AL) is a significant complication after colorectal surgery.
- Assessing blood perfusion at the anastomosis is crucial for preventing AL.
Purpose of the Study:
- To evaluate the efficacy of indocyanine green (ICG) fluorescence angiography (FA) in reducing AL incidence.
- To compare ICG-FA with standard visual assessment of blood perfusion.
Main Methods:
- A single-centre randomized trial included 377 patients undergoing stapled colorectal anastomosis.
- Patients were randomized to either ICG-FA or standard visual assessment (non-ICG FA group).
- Primary endpoint was the incidence of AL; secondary outcomes included postoperative complications.
Main Results:
- ICG-FA identified impaired perfusion in 19% of cases.
- Overall AL incidence was lower in the ICG-FA group (9.1%) compared to the non-ICG FA group (16.3%), P=0.04.
- A significant reduction in AL was observed for low colorectal anastomoses (14.4% vs 25.7%, P=0.04), but not for high anastomoses.
Conclusions:
- ICG fluorescence angiography is associated with a reduction in anastomotic leakage.
- The benefit was most pronounced in low anterior resections, suggesting its utility in complex cases.
Aim:
Our aim was to evaluate the efficacy of indocyanine green (ICG) fluorescence angiography (FA) in reducing the incidence of anastomotic leakage (AL) following colorectal anastomosis.
Method:
A single-centre randomized trial was undertaken between 2018 and 2019. Those patients who underwent a stapled colorectal anastomosis were randomized 1:1 for ICG FA versus visual clinical assessment of blood perfusion of the anastomosed colon and rectal stump (non-ICG FA group). The primary end-point was to assess whether ICG FA was associated with a reduction in the incidence of AL. Secondary outcomes were the rate of postoperative complications and change in the level of bowel resection.
Results:
A total of 380 patients undergoing sigmoid and rectal resection were enrolled. After randomization, three patients were excluded. The results of 377 cases were available for analysis; 187 had ICG FA and 190 were in the non-ICG FA group. ICG FA identified impaired blood perfusion of the colon in 36 (19%) cases. An AL (grade A, B or C) developed in 48 patients: 17 (9.1%) in the ICG FA group and 31 (16.3%) in the non-ICG FA group (P = 0.04). ICG FA did not decrease the rate of AL of high anastomoses (9-15 cm from the anal verge), at 1.3% vs 4.6% in the non-ICG FA group (P = 0.37). In contrast, a decrease in AL rate was found for low (4-8 cm) colorectal anastomoses (14.4% in ICG FA vs 25.7% in the non-ICG FA group; P = 0.04).
Conclusion:
ICG FA is associated with a reduction in AL following low anterior resection.
