Laparoscopic Clipping of the Inferior Mesenteric Artery and Intraoperative Indocyanine Green Angiography for Type II Endoleak Following Endovascular Aneurysm Repair

Porta, Massimiliano Della; Cova, Marta; Segreti, Sara; Asti, Emanuele; Milito, Pamela; Trimarchi, Santi; Bonavina, Luigi

doi:10.1089/lap.2019.0766

Cited by 5 publications

(18 citation statements)

References 16 publications

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“…Porta et al. demonstrated its usefulness in the laparoscopic treatment of a T2E 5 . We hereby further demonstrate the feasibility and safety of a total robotic approach with the added reassurance of ICG perfusion intra‐operatively.…”

Section: Introductionsupporting

confidence: 57%

“…4 A handful or case reports and consecutive patient series have reported satisfactory surgical management via a laparoscopic approach. [5][6][7] While this is safe and feasible, a robotic approach may allow for a better clarity of dissection especially within the context of anatomically disrupted surgical dissection planes. Morelli et al, have demonstrated safe total robotic ligation of the IMA and feeding lumbar vessels in the management of persistent T2E.…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines have advocated treatment when the sac diameter reaches or exceeds 10 mm 4 . A handful or case reports and consecutive patient series have reported satisfactory surgical management via a laparoscopic approach 5–7 . While this is safe and feasible, a robotic approach may allow for a better clarity of dissection especially within the context of anatomically disrupted surgical dissection planes.…”

Section: Introductionmentioning

confidence: 99%

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Indocyanine green colonic perfusion demonstration following robotic da Vinci X inferior mesenteric artery ligation for the treatment of type II endoleak

Lambert

Majid

Salaman

et al. 2022

Robotics Computer Surgery

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Background We describe the technical operative details of the robotic repair of a type II endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR). We demonstrate that indocyanine green (ICG) can be used intra‐operatively to demonstrate perfusion of the colon following ligation of the inferior mesenteric artery (IMA) vessel feeding the aneurysm sac. Methods A 74‐year old male underwent EVAR for a 5.8 cm infra‐renal abdominal aortic aneurysm using an E‐Tegra, Jotec Device (JOTEC Gmb, Lotzenäcker 23,D‐72379 Hechingen). Surveillance contrast CT (CTA) over the ensuing 30 months confirmed progressive sac expansion. Results ICG confirmed colonic perfusion via the marginals after IMA ligation. Total operative time 56 min < 50 mls blood loss and 1‐day hospital stay. 3‐month follow‐up: CTA and ultrasound demonstrated complete resolution of T2E and adequately perfused colon. Conclusion A total robotic approach can be performed safely with intra‐operative ICG used to demonstrate colonic perfusion as an added safety measure.

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Section: Introductionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Indocyanine green colonic perfusion demonstration following robotic da Vinci X inferior mesenteric artery ligation for the treatment of type II endoleak

Lambert

Majid

Salaman

et al. 2022

Robotics Computer Surgery

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“…8 More recently, ICG has been used successfully to determine colonic perfusion after IMA ligation for type II endoleak management. 9,10 Given the good safety profile and its utility in assessing perfusion, this case series aimed to determine whether ICG could be used safely to determine colonic perfusion during OR. To the best of our knowledge this is the first case series utilizing ICG in open aneurysm repair to interrogate colonic perfusion.…”

Section: Introductionmentioning

confidence: 99%

“…8 ⁠⁠ More recently, ICG has been used successfully to determine colonic perfusion after IMA ligation for type II endoleak management. 9,10…”

Section: Introductionmentioning

confidence: 99%

Indocyanin Green Fluorescence Evaluation of Colonic Perfusion During Elective Open Abdominal Aortic Aneurysm Repair

Tam

Abdel-Rahim

Dix

et al. 2023

Vasc Endovascular Surg

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Objectives Colonic ischaemia is a rare but devastating complication of open aortic aneurysm repair and is associated with high morbidity and a mortality of up to 50%. The aim of this study was to determine the safety and effectiveness of using indocyanin green florescence (ICG) to interrogate colonic perfusion intra-operatively. Design Prospective observational study. Methods All elective open abdominal aneurysm repairs over a 6 month period underwent colonic perfusion interrogation with ICG according to a pre-defined protocol. Patient demographics and imaging findings were recorded prior to surgery. ICG was given just prior to laparotomy closure. Time to florescence was measured from the start of IV administration to surgeon defined maximal florescence of the sigmoid colon. Results Ten patients fulfilled the inclusion criteria. All patients were male with an average age of 69.7 years. Inferior mesenteric artery reimplantation was performed in 5 patients. Median colonic fluorescence time was 58 s. No complications related to ICG were identified. A single patient had clinical concern of colonic ischaemia and delayed perfusion (>3 min) on ICG; colorectal opinion advised not for immediate resection. At relook laparotomy, ischaemic colon at the area of demarcation was noted and a Hartmann’s procedure was performed. No other patients had delayed perfusion and no further episodes of colonic ischaemia were noted. IMA reimplantation did not show statistical difference in colonic ICG time ( P = .81, 95% CI -1.98 to 2.45). There was no statistical difference between operating times between the cohort and all repairs performed 6 months before the data collection ( P = .59, 95% CI -.73 to 1.24). Conclusion In this pilot study ICG appears to be a safe and useful adjunct in objective assessment of colonic perfusion during open AAA repair. Further research is required to fully determine its role in this cohort of patients.

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Type 2 Endoleak Management

Chen¹,

Stavropoulos

2020

Semin intervent Radiol

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Type 2 endoleaks are the most common endoleak type following endovascular aneurysm repair. The natural history of these endoleaks can vary, with some demonstrating a self-limited or indolent course, while others can contribute to aneurysm sac enlargement and rupture. A variety of embolization techniques, including transarterial catheterization and direct sac puncture techniques, have been developed for the treatment of type 2 endoleaks. In this article, the authors review the indications, techniques, and outcomes of current treatment strategies for type 2 endoleaks.

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Laparoscopic Clipping of the Inferior Mesenteric Artery and Intraoperative Indocyanine Green Angiography for Type II Endoleak Following Endovascular Aneurysm Repair

Cited by 5 publications

References 16 publications

Indocyanine green colonic perfusion demonstration following robotic da Vinci X inferior mesenteric artery ligation for the treatment of type II endoleak

Indocyanine green colonic perfusion demonstration following robotic da Vinci X inferior mesenteric artery ligation for the treatment of type II endoleak

Indocyanin Green Fluorescence Evaluation of Colonic Perfusion During Elective Open Abdominal Aortic Aneurysm Repair

Type 2 Endoleak Management

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