Optimizing quantitative fluorescence angiography for visceral perfusion assessment
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and Other Interventional Techniques
REVIEW ARTICLE
Optimizing quantitative fluorescence angiography for visceral perfusion assessment Christian D. Lütken1 · Michael P. Achiam1 · Morten B. Svendsen2 · Luigi Boni3 · Nikolaj Nerup1 Received: 30 April 2020 / Accepted: 10 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Compromised tissue perfusion is a significant risk factor for anastomotic leakage after intestinal resection, leading to prolonged hospitalization, risk of recurrence after oncologic resection, and reduced survival. Thus, a tool reducing the risk of leakage is highly warranted. Quantitative indocyanine green angiography (Q-ICG) is a new method that provides surgeons with an objective evaluation of tissue perfusion. In this systematic review, we aimed to determine the optimal methodology for performing Q-ICG. Method A comprehensive search of the literature was performed following the PRISMA guidelines. The following databases were searched: PubMed, Embase, Scopus, and Cochrane. We included all clinical studies that performed Q-ICG to assess visceral perfusion during gastrointestinal surgery. Bias assessment was performed with the Newcastle Ottawa Scale. Results A total of 1216 studies were screened, and finally, 13 studies were included. The studies found that intensity parameters (maximum intensity and relative maximum intensity) could not identify patients with anastomotic leakage. In contrast, the inflow parameters (time-to-peak, slope, and t1/2max) were significantly associated with anastomotic leakage. Only two studies performed intraoperative Q-ICG while the rest performed Q-ICG retrospectively based on video recordings. Studies were heterogeneous in design, Q-ICG parameters, and patient populations. No randomized studies were found, and the level of evidence was generally found to be low to moderate. Conclusion The results, while heterogenous, all seem to point in the same direction. Fluorescence intensity parameters are unstable and do not reflect clinical endpoints. Instead, inflow parameters are resilient in a clinical setting and superior at reflecting clinical endpoints. Keywords Fluorescence angiography · Quantification · Indocyanine green · Anastomotic leakage · Optimization One of the most feared complications following gastrointestinal surgery is anastomotic leakage (AL). AL is a complication with potentially dire consequences. Studies have shown an increased length of hospitalization, increased health
* Christian D. Lütken [email protected] 1
Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen Ø, Denmark
2
Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen Ø, Denmark
3
Department of Surgery, Fondazione IRCCS-Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy
expenses, increased risk of r
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