Study Design: We first present 2 cases of spinal arteriovenous fistulae (AVFs) successfully treated with the help of intra-arterial indocyanine green (ICG) angiography.
Objective: To demonstrate the efficacy of intra-arterial ICG angiography in spinal AVFs compared with the role of intravenous ICG injection and intraoperative digital subtraction angiography (DSA).
Summary Of Background Data: Intravenous ICG fluorescent angiography is an emerging intraoperative tool to recognize vascular anatomy. The technique is quite simple and provides real-time vascular hemodynamics in the operative field. However, it takes time for the ICG to be washed out; therefore, repeat studies are somewhat tedious and time consuming, especially in spinal AVFs with multiple shunts/drainer. In this setting, intraoperative DSA has still been the standard to confirm the complete obliteration, although this has a risk of radiation exposure and renal failure.
Methods: Two patients, a 46-year-old man with spinal dural AVF at the cervicomedullary junction and a 68-year-old woman with spinal perimedullary AVF at the conus medullaris, were surgically treated with the help of intra-arterial ICG angiography.
Results: We introduced a catheter into the target artery and injected 0.05 mg ICG in 2 mL of normal saline in multiple, short intervals. This approach enabled us to detect the residual shunt/drainer and confirm complete obliteration. With this technique, a tiny amount of ICG was used in the operative field to clearly label only the affected vessels. Intraoperative DSA was not performed in these cases.
Conclusion: These cases demonstrate that intra-arterial ICG angiography is a powerful tool for visualizing spinal AVFs in terms of addressing the disadvantages of intravenous ICG injection and intraoperative DSA.
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