**1. Introduction**

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80 Artery Bypass

The number of patients with arteriosclerotic disease requiring revascularization surgery such as coronary arterial bypass grafting (CABG) is increasing [1]. In CABG, off-pump CABG (OPCAB) has reduced incidence of operative mortality, which was reported to be as low as 0.6% in the Japanese database of 2009 cases and has enabled surgical treatment for those patients who could not tolerate conventional CABG under cardiac arrest [1]. However, offpump technique can adversely deteriorate the quality of coronary anastomosis due to technical difficulties, potentially leading to a higher rate of graft occlusion or stenosis [2]. In addition, surgery for peripheral arterial disease (PAD) has become more complicated due to an increas‐ ing number of patients with longer period of chronic renal failure [3]. They often necessitate revascularization surgery to the paramalleolar arteries.

In both groups, quality of anastomosis affects the prognosis: an inadequate graft perfu‐ sion in CABG deteriorates cardiac function while that in PAD patient may lead to an amputation of ischemic limb. Graft patency and quality of anastomosis has been evaluat‐ ed postoperatively by means of fluoroscopic angiography or computed tomography angiography (CTA). However, a redo surgery for restoring an adequate perfusion based on these assessment has a higher risk compared to the primary surgery, and thus intraoper‐ ative assessment of graft is desirable. Since intraoperative coronary angiography (CAG) is not necessarily feasible unless hybrid operating room is equipped, transit time flowmeter (TTF) has been employed [4, 5]. However, it does not provide morphological information and some alternative to fluoroscopic CAG is anticipated. Indocyanine green (ICG) angiog‐ raphy could be an alternative.

© 2013 Yamamoto et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Intestinal ischemia remains a devastating complication in vascular surgery, especially in surgical repair of abdominal aortic aneurysms (AAA) [6, 7]. The incidence of intestinal ischemia in elective surgery for AAA and emergency surgery for ruptured AAA is reported to be 6% and 42%, respectively [6, 7]. In cases of suspected intestinal ischemia, however, it is not easy to make a treatment strategy of either revascularization or intestinal resection based on the inspection and digital palpation. ICG imaging system may provide an another useful clue for decision-making [8].

In this chapter, basic principles to the clinical applications of ICG imaging in cardiovascular surgery are described [9].
