Anastomotic leakage (AL) after colorectal surgery leads to substantial morbidity and mortality. Theoretically, compromised blood flow caused by mesenteric artery (MA) stenosis may create suboptimal healing conditions at the anastomotic site, increasing susceptibility to AL. The association between MA stenosis on pre-operative computed tomography (CT) scans and AL in patients undergoing colorectal surgery was investigated. A multicentre, retrospective, frequency matched, nested 1:5 case control study was conducted in the Netherlands. For each patient with AL, five controls without AL were recruited from the same database matched for age and body mass index. Pre-operative CT scans were blindly assessed to identify MA stenosis ≥ 50% as the primary outcome and atherosclerotic burden and vascular pathology as secondary outcomes. A total of 130 patients with AL and 627 matched controls without AL were included. The prevalence of stenosis ≥ 50% in the superior mesenteric artery (SMA) was higher in patients with AL compared with controls (13.8% vs. 2.2%; p < .001). Stenosis ≥ 50% in the inferior mesenteric artery (IMA) also showed a higher prevalence in patients with AL (24.6% vs. 12.1%; p < .001). Multivariate regression analysis showed a 5.9 times higher risk (95% confidence interval [CI] 2.78 - 12.60,; p < .001) of AL in patients with SMA stenosis and 2.1 times higher risk for patients with IMA stenosis (95% CI 1.11 - 3.63; p = .007). Stenosis ≥ 50% of the coeliac artery showed no association with the occurrence of AL. The presence of SMA or IMA stenosis ≥ 50% on pre-operative CT scans is associated with a six and two times higher odds for AL, respectively, when corrected for known risk factors for AL. Whether preventive stent placement reduces the risk of AL still needs to be investigated.

The superiority of indocyanine green fluorescence angiography (ICG-FA) to the clinical eye alone to assess tissue perfusion has been demonstrated in various surgical fields. This short report demonstrates the in vivo use of ICG-FA to assess skin perfusion before ligating the external iliac artery (EIA) to exclude a common femoral artery (CFA) aneurysm. A 70-year-old man presented with a CFA aneurysm after a previous transfemoral amputation. Ligation of the EIA was proposed, but concerns about tissue perfusion warranted a careful approach. The CFA was exposed using an infra-inguinal incision. Intra-operative ICG inflow and washout patterns were semi-quantitatively analysed to assess dermal perfusion of the femoral stump before and after EIA clamping. Based on similar patterns, distal EIA ligation was performed without ischaemic complications. Indocyanine green fluorescence angiography is a promising technique for in vivo assessment of tissue perfusion in peripheral arterial disease, but standardised protocols for perfusion quantification are required to more accurately predict tissue viability.

To investigate the feasibility of quantitative fluorescence angiography with intra-arterial dye injection (Q-iaFA) for intraoperative guidance during revascularization procedures in patients with chronic limb-threatening ischemia (CLTI). In this observational cohort study, 14 patients with CLTI undergoing endovascular intervention were included. Q-iaFA was performed directly before and after revascularization. The parameters time to peak (TTP) and normalized peak slope (PS_norm) were derived from intensity-time curves that were measured on the plantar side of the foot in five regions of interest. The main outcome was defined as the change in these Q-iaFA parameters between pre- and postoperative measurements in the region of interest with the most inferior preoperative value. Expected impact of revascularization was classified into strong, moderate or absent, based on intraoperative radiographic imaging and the Trans-Atlantic Inter-Society II standards. Q-iaFA was successful without complications in all patients. Revascularization impact was classified as strong in 8 (57%), moderate in 5 (36%), and as absent in 1 (7%) patients. In the strong impact group, a significant decrease in TTP and increase in PS_norm was observed (P = .004). The same trend was less pronounced in the moderate impact group, without statistical significance (P = .104 and P = .094). Conversely, in the patient with no expected revascularization impact, TTP increased and PS_norm decreased. Q-iaFA is a feasible technique to evaluate peripheral tissue perfusion during vascular interventions. The extracted perfusion parameters are directly affected by revascularization of arterial lesions in patients with CLTI. This finding suggests that Q-iaFA may be useful to guide intraoperative decision making. Work is required to refine quantification strategies and relate Q-iaFA parameters to clinical outcomes.