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    PloS one. 2014 Aug 21. doi: 10.1371/journal.pone.0103649. pii: PONE-D-14-14898. pmc: PMC4140719
    Indocyanine green video angiography predicts outcome of extravasation injuries.
    Haslik W1,  Pluschnig U2,  Steger GG3,  Zielinski CC4,  Schrögendorfer KF5,  Nedomansky J6,  Bartsch R7,  Mader RM8
    Author information
    1Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    2Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    3Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    4Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    5Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    6Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    7Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    8Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria.
    Abstract

    BACKGROUND: Extravasation of cytotoxic drugs is a serious complication of systemic cancer treatment. Still, a reliable method for early assessment of tissue damage and outcome prediction is missing. Here, we demonstrate that the evaluation of blood flow by indocyanine green (ICG) angiography in the extravasation area predicts for the need of surgical intervention.

    METHODS: Twenty-nine patients were evaluated by ICG angiography after extravasation of vesicant or highly irritant cytotoxic drugs administered by peripheral i.v. infusion. Tissue perfusion as assessed by this standardized method was correlated with clinical outcome.

    RESULTS: The perfusion index at the site of extravasation differed significantly between patients with reversible tissue damage and thus healing under conservative management (N = 22) versus those who needed surgical intervention due to the development of necrosis (N = 7; P = 0.0001). Furthermore, in patients benefiting from conservative management, the perfusion index was significantly higher in the central extravasation area denoting hyperemia, when compared with the peripheral area (P = 0.0001).

    CONCLUSIONS: In this patient cohort, ICG angiography as indicator of local perfusion within the extravasation area was of prognostic value for tissue damage. ICG angiography could thus be used for the early identification of patients at risk for irreversible tissue damage after extravasation of cytotoxic drugs.


    Publikations ID: 25144707
    Quelle: öffnen
     
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