Research Article| Volume 62, ISSUE 2, P267-271, March 2023

Indocyanine Green Fluorescence Angiography in Minor Lower Extremity Amputations: A Useful Technique?


      Complications remain despite conventional methods aimed at improving survivorship of lower extremity amputations. High rates of wound dehiscence, readmission, and revision surgery warrant the development of innovative methods to improve amputation survivorship. One such method employs the use of indocyanine green dye (ICG); an inert chemical injected intraoperatively which can be used to visualize dermal blood flow in real time. There is little objective data available to help guide the use of indocyanine green in limb salvage procedures. The present study compares a group of 31 patients undergoing minor lower extremity amputation with the use of indocyanine green with a control group of 62 patients in which traditional methods were used. Minimum follow-up of 9 months was obtained, leaving 93 patients in total for analysis. Success was defined as a healed amputation within 60 days of follow-up. Uneventful amputation healing occurred in 35.5% and 33.9% of indocyanine green and control patients, respectively. Overall, there was no significant difference in outcomes between groups (p = .965), or success versus failure (p = 1.0). Patient undergoing minor lower extremity amputation with the use of ICG fluorescence angiography did not have statistically inferior outcomes to patients who underwent amputations at the same level with traditional assessments of perfusion. Further research involving the use of this technique is warranted.

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        • Jencks SF
        • Williams MV
        • Coleman EA.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        New Engl J Med. 2009; 360: 1418-1428
        • Curran T
        • Zhang JQ
        • Lo RC
        • Fokkema M
        • McCallum JC
        • Buck DB
        • Darling J
        • Schermerhorn ML.
        Risk factors and indications for readmission after lower extremity amputation in the American College of Surgeons National Surgical Quality Improvement Program.
        J Vasc Surg. 2014; 60: 1315-1324
        • Dzurinko VL
        • Gurwood AS
        • Price JR.
        Intravenous and indocyanine green angiography.
        J Am Optom Assoc. 2004; 75: 743-755
        • Phillips BT
        • Lanier ST
        • Conkling N
        • Wang ED
        • Dagum AB
        • Ganz JC
        • Khan SU
        • Bui DT.
        Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.
        Plast Reconstr Surg. 2012; 129: 778-788
        • Zimmermann A
        • Roenneberg C
        • Wendorff H
        • Holzbach T
        • Giunta RE
        • Eckstein HH.
        Early postoperative detection of tissue necrosis in amputation stumps with indocyanine green fluorescence angiography.
        Vasc Endovasc Surg. 2010; 44: 269-273
        • Lin CW
        • Armstrong DG
        • Lin CH
        • Liu PH
        • Hung SY
        • Lee SR
        • Huang CH
        • Huang YY.
        Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period.
        BMJ Open Diabetes Res Care. 2009; 7e000795
        • Yang AE
        • Hartranft CA
        • Reiss A
        • Holden CR.
        Improving outcomes for lower extremity amputations using intraoperative fluorescent angiography to predict flap viability.
        Vasc Endovasc Surg. 2018; 52: 16-21
        • Van Den Hoven P
        • Van Den Berg SD
        • Van Der Valk JP
        • Van Der Krogt H
        • Van Doorn LP
        • Van De Bogt KE
        • Van Schaik J
        • Schepers A
        • Vahrmeijer AL
        • Hamming JF
        • Van Der Vorst JR
        Assessment of tissue viability following amputation surgery using near-infrared fluorescence imaging with indocyanine green.
        Ann Vasc Surg. 2021; 78: 281-287
        • Armstrong DG
        • Swerdlow MA
        • Armstrong AA
        • Conte MS
        • Padula WV
        • Bus SA.
        Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer.
        J Foot Ankle Res. 2020; 13: 1-4
        • van Haelst ST
        • Teraa M
        • Moll FL
        • de Borst GJ
        • Verhaar MC
        • Conte MS.
        Prognostic value of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification in patients with no-option chronic limb-threatening ischemia.
        J Vasc Surg. 2018; 68: 1104-1113
        • Settembre N
        • Kauhanen P
        • Albäck A
        • Spillerova K
        • Venermo M.
        Quality control of the foot revascularization using indocyanine green fluorescence imaging.
        World J Surg. 2017; 41: 1919-1926