Indocyanine green (ICG) is a fluorescent dye widely used in angiography to visualize blood circulation for various applications, including intra-surgical monitoring. However, fluorescent dyes bind only to plasma components, which results in the imaging of bulk blood flow and does not permit direct observation of erythrocyte dynamics.
Imaging of erythrocyte dynamics would give surgeons a way of quickly establishing whether repaired tissues are sufficiently oxygenated and detect pathologies in the microcirculation. Many surgeries could benefit from a simple erythrocyte imaging technique to reduce complications from anastomotic leakage and insufficient tissue oxygenation. These surgeries include many abdominal surgeries, colorectal surgeries, vascular and plastic reconstructive surgeries.
ICG-loaded erythrocyte angiography is a clinical tool similar to conventional ICG angiography, but it has a wider spectrum of applications. The imaging data generated is directly related to the metabolic capacity and status of blood flow, whereas conventional angiography is completely insensitive to the difference between normal and dangerously low hematocrit.
US and European patents have been granted on the method of loading ICG as well as therapeutic substances into erythrocytes. The technology is at TRL2. Though the concept of erythrocyte imaging has already been tested in monkey and limited human trials, these trials have been mostly limited to the retina. There is still further research needed to apply the concept in the surgical environment.
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