Surgical Microscope with Fluorescein for Vascular Pathology: Myth or Reality?
Does microscope-integrated fluorescein videoangiography add value in vascular surgery or is it just a trend? In this unbiased evidence framework I review the available series in aneurysms, arteriovenous malformations and bypass surgery.
In six series with 242 aneurysm patients, fluorescein lets the surgeon see flow in the eyepieces, in three dimensions and in real time, and in comparative studies it showed perforators better than indocyanine green in a subset of cases (100% vs. 82%). However, there are no randomized trials, the evidence comes from single-center series without clinical outcomes, and agreement with postoperative CT angiography was 84%.
The answer is reality, but a limited one: it is useful in aneurysm clipping when perforators, small branches or deep fields need to be assessed, as a final check, and without replacing angiography in complex cases.
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