title: Quantitative assessment of the free jejunal graft perfusion.
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.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Kinji
authors.initials: K
authors.lastname: Kamiya
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: unno@hama-med.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Unno
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Sano
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hiramatsu
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ohta
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamatodani
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mineta
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: D000368:Aged; D064592:Autografts / Q000098:blood supply*; D004396:Coloring Agents; D016629:Esophagectomy; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007208:Indocyanine Green; D007583:Jejunum / Q000098:blood supply / Q000637:transplantation*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D010611:Pharyngectomy; D012189:Retrospective Studies
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Esophageal cancer; Fluorescence angiography; Free jejunal graft; Indocyanine green; Pharyngoesophagectomy