Intraoperative use of optical coherence angiography in ischemic bowel disease: a pilot study

A method, based on optical coherence angiography (OCA), for the intraoperative diagnosis of blood microcirculation in the ischemic intestine has been tested. The pilot clinical study involved 18 patients who had undergone urgent operations for thrombosis of segments II or III of the superior mesenteric artery, as well as for infringement of the bowel and the mesenteric vessels. In the OCA images regions of preserved blood microcirculation in the intestinal wall were characterized by the presence of branched networks of intramural microvessels and a bright background in the OCA images. Regions of the intestine in which the intramural vessels were interrupted or could not be visualized were considered as potentially non-viable. These data were used to determine the boundaries for intestinal resection. In comparison with the traditional method of intraoperative diagnosis of intestinal blood flow, the use of such OCA criteria meant the volume of bowel resection could be decreased by 21.5 [14.1; 36.0]% (p = 0.037). This observation demonstrates the great potential of OСA in the intraoperative detection of the boundaries of damaged and healthy intestinal wall in ischemic bowel disease.