Indocyanine green angiography for prediction of thrombosis in the internal jugular vein.

Abstract

Although rare, thrombosis does occur in the internal jugular vein (IJV), which often leads to detrimental results. The aim of this report is to evaluate the feasibility of intraoperative indocyanine green (ICG) angiography for prediction of IJV thrombosis. From December of 2013 to August of 2014, we performed ICG angiography intraoperatively on patients who underwent free-flap reconstruction with head and neck cancer. Ten flaps from 8 of these patients were chosen where one pedicle artery of a flap was anastomosed to the superior thyroid artery in an end-to-end fashion, and one pedicle vein of the flap was anastomosed to the IJV in an end-to-side fashion. For each case, the time it took for the dye to enter the pedicle artery and exit the pedicle vein into the IJV was measured in seconds (ICG time). These data were compared in 2 groups: group 1, which showed signs of congestion postoperatively and group 2, which showed no signs of congestion. Signs of congestions were defined as purple or blue flap color, rapid capillary refill, swollen flap, and brisk bleeding with dark blood after prick with 23-gauge needle. Of the 10 flaps, 1 flap demonstrated signs of congestion postoperatively and was found with a thrombus in the IJV. The ICG time in this case was significantly longer than the means of ICG time in flaps with no thrombosis (18 ± 0 seconds versus 6.0 ± 1.0). Intraoperative ICG angiography may predict postoperative IJV thrombosis with accuracy.