Department of Vascular Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK.
Vasc Endovascular Surg. 2024 Jan;58(1):42-46. doi: 10.1177/15385744231189361. Epub 2023 Jul 9.
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.
Prospective observational study.
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.
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 ( = .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 ( = .59, 95% CI -.73 to 1.24).
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.
结肠缺血是开放性腹主动脉瘤修复的一种罕见但严重的并发症，其发病率和死亡率高达 50%。本研究旨在确定术中使用吲哚菁绿荧光（ICG）检查结肠灌注的安全性和有效性。
前瞻性观察研究。
在 6 个月的时间内，所有择期开放性腹主动脉瘤修复术均根据预定义方案进行结肠灌注检查。记录患者的人口统计学和影像学检查结果。ICG 在剖腹术关闭前给予。从静脉注射开始到外科医生定义的乙状结肠最大荧光时间测量荧光时间。
10 名患者符合纳入标准。所有患者均为男性，平均年龄 69.7 岁。5 例患者行肠系膜下动脉再植入术。中位结肠荧光时间为 58 秒。未发现与 ICG 相关的并发症。1 例患者出现临床关注的结肠缺血和 ICG 灌注延迟（>3 分钟）；结直肠专家建议不立即行切除术。再次剖腹探查时，在分界区域发现缺血性结肠，并进行了 Hartmann 手术。其他患者无灌注延迟，无结肠缺血进一步发作。IMA 再植入在结肠 ICG 时间上无统计学差异（ =.81，95%CI -1.98 至 2.45）。与数据收集前 6 个月进行的所有修复术相比，该组的手术时间无统计学差异（ =.59，95%CI -.73 至 1.24）。
在这项初步研究中，ICG 似乎是一种安全有效的方法，可用于客观评估开放性腹主动脉瘤修复术中的结肠灌注。需要进一步的研究来充分确定其在这组患者中的作用。
