Comprehensive Monograph on Indocyanine Green (DB09374)

Executive Summary

Indocyanine Green (ICG) is a tricarbocyanine dye with a remarkable history, evolving from a mid-20th-century diagnostic tool into a cornerstone of modern near-infrared (NIR) fluorescence-guided surgery. First approved by the U.S. Food and Drug Administration (FDA) in 1959, its initial applications were centered on measuring cardiac output and hepatic function, leveraging its unique pharmacokinetic profile. This profile is characterized by rapid and strong binding to plasma proteins, which confines the molecule to the intravascular space, and an exclusive, rapid elimination pathway through the liver into the bile without undergoing metabolic alteration.

The advent of sophisticated NIR imaging technologies has catalyzed a renaissance for ICG, transforming it into a versatile intraoperative navigation aid. Its spectral properties, with absorption and emission peaks in the NIR window, allow for deep tissue penetration with a high signal-to-noise ratio, enabling real-time visualization of anatomical structures and physiological processes. Key contemporary applications include ophthalmic angiography for diagnosing choroidal diseases, intraoperative cholangiography to prevent bile duct injury during cholecystectomy, comprehensive perfusion assessment to reduce anastomotic leaks in colorectal surgery and flap necrosis in reconstructive surgery, and high-precision sentinel lymph node mapping in oncologic surgery.