Intraoperative use of indocyanine green fluorescence angiography to determine amputation level: A case report

Abstract

Introduction: Indocyanine green (ICG) angiography has been widely adopted in several medical areas. Given that it allows real-time visualization of blood perfusion and tissue irrigation, its intraoperative utilization may be useful to determine amputation level in patients presenting with diabetic angiopathy or occlusive peripheral artery disease.

Case presentation: A 70-year-old female patient with a significant medical history, including right transtibial amputation due to complications secondary to diabetic microangiopathy, was admitted to the intensive care unit (ICU) of a quaternary care center of Bogotá D.C. (Colombia) after her clinical condition was stabilized following an acute myocardial infarction without ST-segment elevation. On admission to the ICU, an ulcerated lesion with signs of necrosis was observed in the left heel, requiring computed tomography angiography (CT angiography). Based on CT angiography findings, cardiovascular involvement, and the presence of poor-quality vascular beds, the vascular surgery service concluded that she was not a candidate for endovascular treatment and, together with the prosthetics and amputee service, it was decided that transfemoral amputation was the most appropriate option. During surgery, ICG angiography showed adequate perfusion in the proximal third of the leg, so a transtibial amputation was carried out, considering that this level of amputation has benefits in terms of functional rehabilitation and general quality of life.

Conclusion: The intraoperative use of ICG angiography as a complementary tool to determine amputation level made it possible to preserve the greatest amount of viable tissue in our patient. This likely contributed to reducing the risk of postoperative complications, since she did not experience any adverse events and did not require reoperation. Furthermore, this approach led to a decrease in the costs associated with the treatment. However, studies with larger samples are required to confirm its efficacy in this clinical setting.