Usefulness of Indocyanine Green Angiography for Evaluation of Blood Supply in a Reconstructed Gastric Tube During Esophagectomy

Abstract

We report a case of necrosis of a reconstructed gastric tube in a 77-year-old male patient who had undergone esophagectomy. At the time of admission, the patient had active gastric ulcers, but these were resolved by treatment with a proton pump inhibitor. Subtotal esophagectomy with gastric tube reconstruction was performed. Visually, the reconstructed gastric tube appeared to be well perfused with blood. Using indocyanine green (ICG) fluorescence imaging the gastroepiploic vessels were well enhanced and no enhancement was visable 3 to 4 cm from the tip of the gastric tube. Four days after esophagectomy, gastric tube necrosis was confirmed, necessitating a second operation. The necrosis of the gastric tube matched the area that had been shown to lack blood perfusion by ICG angiography imaging. It seems that ICG angiography is useful for the evaluation of perfusion in a reconstructed gastric tube.

Usefulness of fluorescence vascular imaging for evaluating splenic perfusion

“…However, these methods cannot provide accurate assessments of the risk of post‐operative splenic ischemia. However, FVI‐ICG that has been used for lymphography, angiography and sentinel lymph node detection can facilitate the real‐time visualization of vascular tissue itself . Therefore, using FVI‐ICG to evaluate splenic blood perfusion after SPDP‐W is quite rational.…”

“…However, FVI-ICG that has been used for lymphography, angiography and sentinel lymph node detection can facilitate the real-time visualization of vascular tissue itself. [11][12][13][14][15][16][17][18][19][20] Therefore, using FVI- ICG to evaluate splenic blood perfusion after SPDP-W is quite rational.…”

“…8 Recently, there have been many reports regarding the usefulness of intraoperative fluorescence vascular imaging using indocyanine green (FVI-ICG) for assessing blood perfusion within tissues. [11][12][13][14][15][16][17][18][19][20] This technique facilitates the real-time visualization of the haemodynamics of various tissues.…”

Minimally invasive esophagectomy

“…However, absolute quantification of blood flow is not possible and preliminary data are controversial ( Fig. 9; [103][104][105][106][107][108][109][110]).…”

Factors Affecting Blood Flow at the Tip of the Reconstructed Gastric Tube During Esophagectomy: A Study Using Indocyanine Green Fluorescence Angiography

“…Several reported studies have assessed blood flow in the reconstructed gastric tube using laser Doppler flowmetry [8][9][10][11] or indocyanine green (ICG) fluorescence angiography. [12][13][14][15][16] We previously investigated in detail the hemodynamics of the reconstructed gastric tube using ICG fluorescence angiography 12 and concluded that the time between initial ICG enhancement of the root of the right gastroepiploic artery and enhancement at the tip of the gastric tube was a useful parameter for assessment of blood flow to the gastric tube. In addition, we proposed that the gastric tube was divisible into 3 zones according to the dominant arteries present in the greater curvature: zone 1, the area dominated by the right gastroepiploic vessels; zone 2, the area dominated by the left gastro-epiploic vessels (in all cases, the left gastro-epiploic artery being enhanced in a direction opposite to that of physiologic blood flow); and zone 3, the area initially perfused by short gastric vessels (we usually perform esophago-gastrostomy in this zone; Fig.…”