Jonathan D. Braun, Magdiel Trinidad-Hernandez, Diana Perry, David G. Armstrong, Joseph L. Mills
University of Arizona, Tucson, AZ.
OBJECTIVES: Traditional means of evaluating perfusion before and after revascularization are often limited by medial calcinosis, open wounds, prior amputations, and infection. We evaluated the initial application of Indocyanine Green Angiography (ICGA) and developed quantitative, reproducible endpoints of perfusion.
METHODS: ICGA uses a charge-coupled device camera, a laser and intravenous contrast to assess skin surface perfusion. From Jan to Dec 2011, we performed ICGA within 5 days of 22 revascularization procedures in patients with Rutherford V and VI ischemia. We also compared ICGA pre- and post-revascularization in a subset of 9 patients, including one diabetic who underwent peroneal PTA for an ischemic heel ulcer (Figure). We evaluated multiple, quantitative methods to assess perfusion.
RESULTS: Seventeen patients underwent 22 revascularization procedures (5 open, 17 endo). Ten (45%) healed completely while 12 (55%) did not (mean follow-up 4.2 months). Paired analysis of ingress (increase in pixel strength-PxS), ingress rate (slope of increase in PxS), curve integral (AUC in PxS over time) and egress (decrease in PxS from maximum) increased significantly (p<.05) after revascularization. Ingress (60±38 vs. 48±31) and ingress rate (5.0±3.9 vs. 3.2±2.9) trended to be higher in those who healed.
CONCLUSIONS: ICGA provides rapid visual and quantitative information about regional foot perfusion. Further study is warranted to further define the utility of this exciting, new technology.
AUTHOR DISCLOSURES: D. G. Armstrong, Nothing to disclose; J. D. Braun, Nothing to disclose; J. L. Mills, Nothing to disclose; D. Perry, Nothing to disclose; M. Trinidad-Hernandez, Nothing to disclose.
Posted April 2012