Intraoperative Identification of the Shunt Point of Spinal Arteriovenous Malformations by a Selective Arterial Injection of Saline to Subtract Signals of Indocyanine Green: Technical Note

Takamiya, Soichiro; Yamazaki, Kazuyoshi; Tokairin, Kikutaro; Osanai, Toshiya; Shindo, Takashi; Seki, Takahiro; Fujimura, Miki

doi:10.1016/j.wneu.2021.05.019

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“…To determine the resection area, precise identification of AVM area is important. Intraoperative identification of nidus using ICG angiography in patients with AVM of the central nervous system has been reported in several cases [ 10 ]. However, to the best of our knowledge, only three reports of ICG angiography for the GI tract AVM have been reported [ 11 – 13 ], and all of these reports were about AVMs of the small intestine.…”

Section: Discussionmentioning

confidence: 99%

A case report of duodenal arteriovenous malformation: usefulness of intraoperative indocyanine green angiography for precise identification of the lesion

et al. 2022

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Background Arteriovenous malformation (AVM) of the gastrointestinal (GI) tract can cause bleeding. The treatment choice for GI tract AVM is surgical resection of the involved bowel segment with complete resection of the nidus. The AVM formed in the duodenum or pancreatic head could also cause gastrointestinal bleeding, and there are several reports of pancreaticoduodenectomy as its treatment. However, if the area of AVM can be accurately identified during surgery, it may be possible to completely resect the AVM while preserving the organ. We report a case of duodenal AVM in a patient successfully treated with a subtotal stomach-preserving duodenal bulb resection using intraoperative indocyanine green (ICG) angiography technique. Case presentation An 18-year-old man was diagnosed with duodenal AVM after several examinations for anemia and was referred to our hospital for further treatment. Preoperative imaging studies showed that the inflow vessels of this duodenal AVM were the inferior pyloric artery and the superior duodenal artery, and the AVM was localized to the duodenal bulb. Thereafter, stomach-preserving duodenal bulb resection preceded by ligation of the inflow vessels was performed. During the surgery, ICG angiography clearly demonstrated the area, where the nidus was distributed, and a duodenal bulb resection with complete resection of the AVM was successfully performed. There was no recurrence at the 6-month follow-up. Conclusions Intraoperative ICG angiography was a useful procedure for precise identification of the AVM of the GI tract.

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Section: Discussionmentioning

confidence: 99%