Quantitative assessment of the free jejunal graft perfusion

• Published in: The Journal of surgical research Vol. 194; no. 2; pp. 394 - 399
• Main Authors: Kamiya, Kinji, MD, PhD, Unno, Naoki, MD, PhD, FACS, Miyazaki, Shinichiro, MD, PhD, Sano, Masaki, MD, PhD, Kikuchi, Hirotoshi, MD, PhD, Hiramatsu, Yoshihiro, MD, PhD, Ohta, Manabu, MD, PhD, Yamatodani, Takashi, MD, PhD, Mineta, Hiroyuki, MD, PhD, Konno, Hiroyuki, MD, PhD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Aged; Autografts - blood supply; Coloring Agents; Esophageal cancer; Esophagectomy; Female; Fluorescein Angiography; Fluorescence angiography; Free jejunal graft; Humans; Image Processing, Computer-Assisted; Indocyanine Green; Jejunum - blood supply; Jejunum - transplantation; Laryngectomy; Male; Middle Aged; Pharyngectomy; Pharyngoesophagectomy; Retrospective Studies; Surgery; Indocyanine green; Fluorescence angiography; Free jejunal graft; Pharyngoesophagectomy; Esophageal cancer
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2014.10.049

Abstract Background Reconstruction with free jejunal graft (FJG) is often performed for patients with hypopharyngeal or cervical esophageal cancer. During reconstruction with an FJG after pharyngoesophagectomy, it is critical to intraoperatively detect venous anastomotic failure and subsequent venous malperfusion to avoid postoperative FJG necrosis. This study introduces a novel method for assessing blood perfusion in FJGs by using indocyanine green (ICG) fluorescence angiography. Methods We used ICG fluorescence angiography to quantitatively assess FJG blood perfusion in archived fluorescence video files from 26 patients who had undergone FJG transfer. A software program “ROIs”, was used to create a time-fluorescence intensity curve. We retrospectively measured the maximum fluorescence intensity at the terminal ileum and the duration (T1/2max) between when the intensity began rising and when it reached half of the maximum. Results Among the 26 patients, 5 patients suffered venous anastomotic failure. In three of these cases, anastomosis was corrected intraoperatively; the other two patients underwent a second FJG transfer. Retrospective assessment showed that the mean T1/2max at the FJG serosae was significantly longer in these five patients than that in FJGs with good blood perfusion. Our analysis revealed that a T1/2max >9.6 s may be a good indicator of FJG venous malperfusion. Conclusions Quantitative analysis of ICG fluorescence angiography proved useful for detecting venous anastomotic failure of FJG, and may help to reduce vascular problems in FJG reconstruction.