Case Report: Video-Assisted Thoracoscopic Surgery for Pulmonary Arteriovenous Malformation Using Near-Infrared Fluorescence with Indocyanine Green

Background: Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary vasculatures and has an unclear boundary with surrounding lung tissues. At present, surgeons can only determine its location by preoperative imaging and intraoperative palpation, despite its soft texture. Indocyanine green, a near-infrared fluorophore, has been demonstrated useful in the accurate identification of vascular tissue. Therefore, we explored its application in PAVM cases. Case presentation: we present two PAVM cases using near-infrared fluorescence (NIF) with 25 mg ICG at 5 mg/ml to achieve intraoperative visualization of the lesion in video-assisted thoracoscopic surgery (VATS), with one for relieving symptoms and the other for complicated lung disease requiring surgery. Under the NIF mode, ICG systemic injection led to successive signaling of the anomaly and normal tissues in merely 10 seconds, which helped us distinguish them efficiently and precisely. A peak signal-to-background ratio of 2.2 confirmed the significant fluorescence difference as well and excluded interference from carbon dust furthermore. Conclusions: : We are the first to report the use of such an approach in delineating the margin of vascular malformation with high contrast and this new finding may be helpful to minimize the damage to lung function in PAVM treatment. Further exploration and validation are needed to determine its role.