Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Abstract

Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy. In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed. Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion. In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.

Feasibility and efficacy of indocyanine green in monitoring systemic drug leakage during isolated limb perfusion for recurrent melanoma of extremity

“…The lack of fluorescence in other body parts, such as the abdominal wall, ear, and hand, confirms the absence of systemic drug dispersion. ICG usage was first described in deceased animal models for ILP by Zucal et al [12]. To the best of our knowledge, there is no literature suggesting usage of ICG for leakage monitoring during ILP in humans.…”

“…ICG usage was first described in deceased animal models for ILP by Zucal et al . [12]. To the best of our knowledge, there is no literature suggesting usage of ICG for leakage monitoring during ILP in humans.…”

Special Issue “Plastic and Reconstructive Surgery in Personalized Medicine”

“…Müller-Seubert et al demonstrate intra- and early postoperative evaluations of malperfused areas in an irradiated random pattern skin flap model using indocyanine green angiography and near-infrared reflectance-based imaging and infrared thermography [ 21 ]. The value of indocyanine green to control leakage in isolated limb perfusion is described as a new and effective tool by Zucal and coworkers [ 22 ]. In addition, Thiem et al studied the value of hyperspectral imaging for the clinical assessment of free flap monitoring compared to clinical monitoring in a prospective non-randomized clinical trial [ 23 ].…”