Journal of Artificial Organs

, Volume 22, Issue 2, pp 160–168 | Cite as

Evaluation of graft anastomosis using time–intensity curves and quantitative near-infrared fluorescence angiography during peripheral arterial bypass grafting

  • Masaki YamamotoEmail author
  • Hitoshi Ninomiya
  • Miwa Tashiro
  • Takayuki Sato
  • Takemi Handa
  • Keiji Inoue
  • Kazumasa Orihashi
  • Kazuhiro Hanazaki
Original Article Others


Near-infrared fluorescence angiography (NIR) visualizes blood perfusion using the fluorescence property of indocyanine green (ICG). This study aimed to retrospectively determine the usefulness of a quantitative analysis using NIR to predict the patency of peripheral arterial bypass grafts by measuring their fluorescence luminance intensities (FLIs).

Thirteen grafts in 11 patients who underwent peripheral arterial bypass grafting were divided into a patent graft group (n = 7) and a failed graft group (n = 6). The changes in the FLIs of ICG opacification through the graft and distal host artery were retrospectively analyzed using stored NIR data. The time–intensity curves (TICs) of ICG opacification through the graft (Qgraft) and distal host artery (Qdistal) were measured. Two parameters, Δ(QgraftQdistal) and integral(QgraftQdistal), were also analyzed.

Although not significant, decreases in Qgraft were observed in the failed graft groups. The Qdistal of the failed graft group was significantly attenuated as compared with that of the patent graft group. Δ(QgraftQdistal) increased only in the failed graft group, which indicates widening of the gap in FLI. Integral(QgraftQdistal) was higher in the failed graft group, as it reflects the accumulation of ICG opacification.

The TICs were influenced by anastomotic stenosis in the distal site of the host arteries. Our results indicate that the comparison of Δ(QgraftQdistal) and integral (QgraftQdistal) quantitatively analyzed using NIR can potentially predict anastomotic stenosis.


Peripheral arterial bypass graft Near-infrared fluorescence angiography Indocyanine green 



This research was supported by the JSPS KAKENHI (Grant number 20437718) and Fujita Memorial Fund for Medical Research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10047_2018_1083_MOESM1_ESM.tif (1.6 mb)
Supplementary material 1 TICs described from graft no. 10. The TICs were measured from the graft and distal host artery. FLI: fluorescence luminance intensity (TIF 1655 KB)

Supplementary material 2 Near-infrared fluorescence angiographic image. The ICG opacification of the graft and posterior tibial artery (PTA) are shown (graft no. 1 of Table 2) (MPG 7836 KB)

Supplementary material 3 Near-infrared fluorescence angiographic image. The ICG opacification of the graft and posterior tibial artery (PTA) are shown (graft no. 8 of Table 2) (MPG 7460 KB)


  1. 1.
    Yamamoto M, Sasaguri S, Sato T. Assessing intraoperative blood flow in cardiovascular surgery. Surg Today. 2011;41:1467–74.CrossRefGoogle Scholar
  2. 2.
    Braun JD, Trinidad-Hernandez M, Perry D, Armstrong DG, Mills JL Sr. Early quantitative evaluation of indocyanine green angiography in patients with critical limb ischemia. J Vasc Surg. 2013;57:1213–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Benson RC, Kues HA. Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol. 1978;23:159–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Yamamoto M, Orihashi K, Nishimori H, Handa T, Kondo N, Fukutomi T, Sato T. Efficacy of intraoperative HyperEye Medical System angiography for coronary artery bypass grafting. Surg Today. 2015;45:966–72.CrossRefGoogle Scholar
  5. 5.
    Taggart DP, Choudhary B, Anastasiadis K, Abu-Omar Y, Balacumaraswami L, Pigott DW. Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg. 2003;75:870–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Desai ND, Miwa S, Kodama D, Cohen G, Christakis GT, Goldman BS, Baerlocher MO, Pelletier MP, Fremes SE. Improving the quality of coronary bypass surgery with intraoperative angiography: validation of a new technique. J Am Coll Cardiol. 2005;46:1521–5.CrossRefGoogle Scholar
  7. 7.
    Balacumaraswami L, Taggart DP. Intraoperative imaging techniques to assess coronary artery bypass graft patency. Ann Thorac Surg. 2007;83:2251–7.CrossRefGoogle Scholar
  8. 8.
    Azuma N, Koya A, Uchida D, Saito Y, Uchida H. Ulcer healing after peripheral intervention-can we predict it before revascularization? Circ J. 2014;78:1791–800.CrossRefPubMedGoogle Scholar
  9. 9.
    Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y, Kawano T. Quantitative evaluation of the outcomes of revascularization procedures for peripheral arterial disease using indocyanine green angiography. Eur J Vasc Endovasc Surg. 2013;46:460–5.CrossRefPubMedGoogle Scholar
  10. 10.
    D’Ancona G, Bartolozzi F, Bogers AJ, Pilato M, Parrinello M, Kappetein AP. Intraoperative graft patency verification in coronary artery surgery: modern diagnostic tools. J Cardiothorac Vasc Anesth. 2009;23:232–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Yamamoto M, Nishimori H, Handa T, Fukutomi T, Kihara K, Tashiro M, Sato T, Orihashi K. Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting. Surg Today. 2017;47:210–7.CrossRefGoogle Scholar
  12. 12.
    Balacumaraswami L, Abu-Omar Y, Choudhary B, Pigott D, Taggart DP. A comparison of transit-time flowmetry and intraoperative fluorescence imaging for assessing coronary artery bypass graft patency. J Thorac Cardiovasc Surg. 2005;130:315–20.CrossRefPubMedGoogle Scholar
  13. 13.
    Yamamoto M, Nishimori H, Fukutomi T, Handa T, Kihara K, Tashiro M, Sato T, Orihashi K. Influence of vessel stenosis on indocyanine green fluorescence intensity assessed by near-infrared fluorescence angiography. Surg Today. 2017;47:877–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Handa T, Orihashi K, Nishimori H, Fukutomi T, Yamamoto M, Kondo N, Tashiro M. Maximal blood flow acceleration analysis in the early diastolic phase for in situ internal thoracic artery bypass grafts: a new transit-time flow measurement predictor of graft failure following coronary artery bypass grafting. Interact Cardiovasc Thorac Surg. 2015;20:449–57.CrossRefPubMedGoogle Scholar
  15. 15.
    Shintani Y, Iino K, Yamamoto Y, Kato H, Takemura H, Kiwata T. Analysis of computational fluid dynamics and particle image velocimetry models of distal-end side-to-side and end-to-side anastomoses for coronary artery bypass grafting in a pulsatile flow. Circ J. 2017;82:110–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Hirotani T, Kameda T, Shirota S, Nakao Y. An evaluation of the intraoperative transit time measurements of coronary bypass flow. Eur J Cardiothorac Surg. 2001;19:848–52.CrossRefPubMedGoogle Scholar
  17. 17.
    Hol PK, Fosse E, Mork BE, Lundblad R, Rein KA, Lingaas PS, Geiran O, Svennevig JL, Tonnessen TI, Nitter-Hauge S, Due-Tonnessen P, Vatne K, Smith HJ. Graft control by transit time flow measurement and intraoperative angiography in coronary artery bypass surgery. Heart Surg Forum. 2001;4:254–7. (discussion 7–8).PubMedGoogle Scholar

Copyright information

© The Japanese Society for Artificial Organs 2018

Authors and Affiliations

  • Masaki Yamamoto
    • 1
    • 2
    • 3
    Email author
  • Hitoshi Ninomiya
    • 4
    • 5
  • Miwa Tashiro
    • 2
  • Takayuki Sato
    • 3
    • 6
  • Takemi Handa
    • 2
  • Keiji Inoue
    • 3
    • 7
  • Kazumasa Orihashi
    • 2
    • 3
  • Kazuhiro Hanazaki
    • 1
    • 3
    • 8
  1. 1.Department of Operating ManagementKochi Medical School, Kochi UniversityNankokuJapan
  2. 2.Department of Surgery 2Kochi Medical School, Kochi UniversityNankokuJapan
  3. 3.Center for Photodynamic MedicineKochi Medical School, Kochi UniversityNankokuJapan
  4. 4.Integrated Centre for Advanced Medical TechnologiesKochi Medical School, Kochi UniversityNankokuJapan
  5. 5.Faculty of Science and Engineering, Department of Civil and Environmental EngineeringToyo UniversityKawagoeJapan
  6. 6.Department of Cardiovascular ControlKochi Medical School, Kochi UniversityNankokuJapan
  7. 7.Department of UrologyKochi Medical School, Kochi UniversityNankokuJapan
  8. 8.Department of Surgery 1Kochi Medical School, Kochi UniversityNankokuJapan

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