Real time vascular imaging during solid organ transplant

Abstract

The invention provides methods and systems for imaging vessels in a subject. In certain embodiments the vessels may be associated with a solid organ transplant.

1 . A method of intra-operatively determining the patency of at least one vessel which is surgically joined to a transplanted organ in a recipient subject comprising: 
 a. administering a fluorescent dye to the recipient subject;    b. applying a sufficient amount of energy to the vessel such that the fluorescent dye fluoresces;    c. obtaining a fluorescent image of the vessel surgically joined to a transplanted organ; and    d. observing the image to determine if a fluorescent signal is continuous through the vessel, wherein a continuous fluorescent signal in the vessel indicates the vessel is patent.    
     
     
         2 . The method of  claim 1 , wherein the recipient subject is a human.  
     
     
         3 . The method of  claim 1 , wherein the fluorescent dye is a tricarbocyanine dye or an analog thereof.  
     
     
         4 . The method of  claim 3 , wherein the tricarbocyanine dye is indocyanine green.  
     
     
         5 . The method of  claim 1 , wherein the dye is administered intravenously.  
     
     
         6 . The method of  claim 1 , wherein the dye is administered as a bolus injection.  
     
     
         7 . The method of  claim 1 , wherein the dye is administered less than an hour before determining patency.  
     
     
         8 . The method of  claim 1 , wherein the dye is administered more than 30 seconds before determining patency.  
     
     
         9 . The method of  claim 1 , wherein the energy is light energy.  
     
     
         10 . The method of  claim 9 , wherein the light energy is provided by a laser.  
     
     
         11 . The method of  claim 9 , wherein the light energy is provided by an incandescent light and a filter.  
     
     
         12 . The method of  claim 9 , wherein the wavelength of the light energy is in the infra-red spectrum.  
     
     
         13 . The method of  claim 9 , wherein the wavelength of the light energy is about 805 nanometers.  
     
     
         14 . The method of  claim 1 , wherein the image is obtained by a camera.  
     
     
         15 . The method of  claim 14 , wherein the camera is a charge coupled device.  
     
     
         16 . The method of  claim 14 , wherein the camera is a video recorder.  
     
     
         17 . The method of  claim 10 , wherein the laser power output is about 2.5 watts.  
     
     
         18 . The method of  claim 17 , wherein the laser power output lasts for about 30 seconds.  
     
     
         19 . The method of  claim 17 , wherein the output is a continuous wave.  
     
     
         20 . The method of  claim 1 , wherein the vessel is a blood vessel.  
     
     
         21 . The method of  claim 1 , wherein the vessel is an artery.  
     
     
         22 . The method of  claim 1 , wherein the vessel is a vein.  
     
     
         23 . The method of  claim 1 , wherein the vessel is a ureter.  
     
     
         24 . The method of  claim 1 , wherein the vessel is comprised of a duct.  
     
     
         25 . The method of  claim 1 , wherein the organ is chosen from a heart, a liver, a pancreas, a kidney and a lung.  
     
     
         26 . The method of  claim 1 , wherein the organ is a heart and a lung.  
     
     
         27 . The method of  claim 1 , wherein the organ is a pancreas and a kidney.  
     
     
         28 . The method of  claim 1 , wherein the vessel is chosen from an inferior vena cava, superior vena cava, an atrial cuff, an aortic root, an aorta, a pulmonary trunk, a pulmonary vein, a pulmonary artery, a hepatic artery, a hepatic vein, a portal vein, a bile duct, a renal artery, a renal vein, a pancreatic duct, a pancreatic artery, a pancreatic vein, an arterial graft, a venous graft.  
     
     
         29 . The method of  claim 1 , wherein the vessel comprises an anastomosis.  
     
     
         30 . The method of  claim 1 , further comprising a method of determining the patency of at least one vessel which is attached to a donor organ in a donor subject comprising: 
 a. administering a fluorescent dye to the donor subject;    b. applying a sufficient amount of energy to the vessel such that the fluorescent dye fluoresces;    c. obtaining a fluorescent image of the vessel attached to a donor organ; and    d. observing the image to determine if a fluorescent signal is continuous through the vessel,    wherein a continuous fluorescent signal in the vessel indicates the vessel is patent.    
     
     
         31 . The method of  claim 1 , further comprising a method of determining the patency of at least one vessel which is attached to a donor organ comprising: 
 a. administering a fluorescent dye to the vessel attached to the donor organ;    b. applying a sufficient amount of energy to the vessel such that the fluorescent dye fluoresces;    c. obtaining a fluorescent image of the vessel attached to a donor organ; and    d. observing the image to determine if a fluorescent signal is continuous through the vessel,    wherein a continuous fluorescent signal in the vessel indicates the vessel is patent .    
     
     
         32 . The method of  claim 30 , wherein the method is performed ex vivo.  
     
     
         33 . A portable system useful for imaging at least one vessel which is surgically joined to a transplanted organ in a recipient subject comprising : a) a fluorescent dye; b) an energy source capable of emitting sufficient energy such that the fluorescent dye fluoresces; c) an imaging head.  
     
     
         34 . The system of  claim 33 , wherein the fluorescent dye is a tricarbocyanine dye or an analog thereof.  
     
     
         35 . The system of  claim 34 , wherein the tricarbocyanine dye is indocyanine green.  
     
     
         36 . The system of  claim 33 , wherein the energy source is a laser.  
     
     
         37 . The system of  claim 36 , wherein the laser emits infra red light.  
     
     
         38 . The system of  claim 33 , wherein the imaging head comprises a camera.  
     
     
         39 . The system of  38 , wherein the camera is a charge coupled device.  
     
     
         40 . A portable system useful for imaging at least one vessel which is surgically joined to a transplanted organ in a recipient subject comprising: 
 a. a fluorescent dye;    b. an energy source capable of emitting sufficient energy such that the fluorescent dye fluoresces;    c. an imaging head;    d. an articulating arm;    e. a computer and monitor;    f. image processing software;    g. an electrical power source; and    h. a housing for containing a-g, wherein the housing comprises at least 2 wheels.    
     
     
         41 . The system of  claim 40  further comprising a motion sensor.  
     
     
         42 . The system of  claim 40  further comprising a distance sensor.  
     
     
         43 . The system of  claim 40  further comprising a sterile drape.  
     
     
         44 . The system of  claim 40  further comprising a printer.  
     
     
         45 . The system of  claim 40 , wherein the articulating arm comprises a horizontal section.  
     
     
         46 . The system of  claim 40 , wherein the housing is a mobile cart.  
     
     
         47 . The system of  claim 46 , wherein the mobile cart comprises four wheels.  
     
     
         48 . The system of  claim 40 , wherein the imaging head comprises a camera.  
     
     
         49 . The system of  claim 48 , wherein the camera is a charge coupled device.  
     
     
         50 . The system of  claim 40 , wherein the imaging head, the motion sensor, and the distance sensor are attached to the articulating arm.  
     
     
         51 . The system of  claim 40 , wherein the mobile cart houses the electrical power source, the printer, the computer, and the energy source.  
     
     
         52 . The system of  claim 40 , wherein the energy source is a laser.  
     
     
         53 . The system of  claim 40 , further comprising a syringe to administer the fluorescent dye to a subject.  
     
     
         54 . The system of  claim 45 , wherein the articulating arm provides six degrees of freedom for the imaging head.  
     
     
         55 . The system of  claim 40 , wherein the energy is light energy.  
     
     
         56 . The system of  claim 55 , wherein the light energy has a wavelength in the infra-red spectrum.  
     
     
         57 . The system of  claim 56 , wherein the light energy has a wavelength of about  805  nanometers.  
     
     
         58 . The system of  claim 40 , wherein the sterile drape is comprised of a transparent aperture such that the energy passes through the sterile drape.  
     
     
         59 . The system of  claim 40 , wherein the fluorescent dye is a tricarbocyanine dye or an analog thereof.  
     
     
         60 . The system of  claim 40 , wherein the tricarbocyanine dye is indocyanine green.  
     
     
         61 . The system of  claim 40  further comprising an instruction booklet.  
     
     
         62 . The system of  claim 40 , wherein the system is free standing.  
     
     
         63 . The system of  claim 40 , wherein the system is not required to be hand held.  
     
     
         64 . The system of  claim 40 , wherein the imaging head is contained in an endoscope.  
     
     
         65 . The method of  claim 1 , wherein the vessel is from a biological source.  
     
     
         66 . The method of  claim 65 , wherein the graft is chosen from an allograft, an autograft and a xenograft.  
     
     
         67 . The method of  claim 1 , wherein the vessel is from a synthetic source.