Indocyanine Green Angiography Aids in Prediction of Limb Salvage in Vascular Trauma

• Published in: Annals of vascular surgery Vol. 29; no. 7; pp. 1453.e1 - 1453.e4
• Main Authors: Connolly, Peter H, Meltzer, Andrew J, Spector, Jason A, Schneider, Darren B
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.10.2015
• Subjects: Accidents, Traffic; Adolescent; Angiography, Digital Subtraction; Ankle Fractures - diagnosis; Ankle Fractures - etiology; Ankle Fractures - physiopathology; Ankle Fractures - therapy; Decision Support Techniques; Female; Fluorescent Dyes - administration & dosage; Fracture Fixation, Internal; Fracture Healing; Humans; Indocyanine Green - administration & dosage; Infusions, Intra-Arterial; Limb Salvage - methods; Nitroglycerin - administration & dosage; Pedestrians; Perfusion Imaging - methods; Predictive Value of Tests; Recovery of Function; Regional Blood Flow; Surgery; Tibial Arteries; Tissue Survival; Treatment Outcome; Vascular System Injuries - diagnosis; Vascular System Injuries - etiology; Vascular System Injuries - physiopathology; Vascular System Injuries - therapy; Vasodilator Agents - administration & dosage
• ISSN: 0890-5096; 1615-5947
• DOI: 10.1016/j.avsg.2015.04.090

Background In cases of severe vascular trauma, traditional means for assessing viability using Doppler and angiography can have limited application. Indocyanine green angiography (ICGA) allows for a rapid qualitative assessment of tissue perfusion that serves as an important adjunct to these traditional methods, which can also be particularly helpful in guiding therapy. Methods/Results We present a case of complicated ankle fracture with severe vascular compromise, which illustrates the role of ICGA as an assessment tool to guide therapy and decision-making in cases of acute limb threat. ICGA using SPY system (Novadaq, Bonita Springs, FL) was performed as part of our initial assessment to evaluate the extent of malperfusion and potential for revascularization. Preprocedural imaging with ICGA showed very limited uptake in the foot. Treatment was also performed with traditional angiography and infusion of intra-arterial nitroglycerin into the posterior tibial artery. Postprocedure imaging with ICGA was performed a day later and showed marked difference in the perfusion profile, with rapid uptake into the forefoot and toes, which corresponded with the patient's clinical improvement. The patient went on to have complete limb salvage. Conclusions The addition of ICGA for assessment of tissue perfusion in cases of complex vascular trauma has several implications: it guides surgical therapy for excision of devitalized tissue and aids in decision-making for major considerations such as revascularization efforts or amputation.