title: Intraoperative localization of arteriovenous malformation of a jejunum with combined use of angiographic methods and indocyanine green injection: Report of a new technique.
abstract: BACKGROUND
  The localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. The use of indocyanine green (ICG) is effective in aiding intraoperative localization if a bleeding lesion is identified on angiography.
  
  
  METHODS
  A 95-year-old Japanese man presented with hematochezia. Selective angiography of the superior mesenteric artery (SMA) established an arteriovenous malformation (AVM). ICG injection into the feeding vessel was administered intraoperatively, and the demarcated segment of the jejunum was resected.
  
  
  CONCLUSIONS
  Diluted ICG was injected in the SMA by intraoperative angiography, and the region could be easily and clearly visualized by the ICG fluorescence imaging; small patchy poolings of ICG were recognized. Ultimately, the region was diagnosed as an AVM of the jejunum. To the best of our knowledge, this is the first reported description of this technique.
  
  
  CONCLUSIONS
  Our new technique of combining selective angiography with intraoperative ICG injection and focused enterectomy is a safe, accurate, and cost-effective treatment.
authors.affiliation: Department of Internal Medicine, Seiwa Memorial Hospital, 1-1, 1-Jo, 5-Chome, Kotoni, Nishi-ku, Sapporo 063-0811, Japan. Electronic address: hiro_docto@yahoo.co.jp.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ono
authors.affiliation: Department of Surgery, Seiwa Memorial Hospital, 1-1, 1-Jo, 5-Chome, Kotoni, Nishi-ku, Sapporo 063-0811, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kusano
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Futoshi
authors.initials: F
authors.lastname: Kawamata
authors.affiliation: Department of Surgery, Seiwa Memorial Hospital, 1-1, 1-Jo, 5-Chome, Kotoni, Nishi-ku, Sapporo 063-0811, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Danjo
authors.affiliation: Department of Internal Medicine, Seiwa Memorial Hospital, 1-1, 1-Jo, 5-Chome, Kotoni, Nishi-ku, Sapporo 063-0811, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kawakami
authors.affiliation: Department of Anesthesiology, Seiwa Memorial Hospital, 1-1, 1-Jo, 5-Chome, Kotoni, Nishi-ku, Sapporo 063-0811, Japan.
authors.forename: Kimimoto
authors.initials: K
authors.lastname: Nagashima
authors.affiliation: Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishihara
keywords: Arteriovenous malformation; ICG fluorescence imaging; Indocyanine green; Superior mesenteric artery angiography