Indocyanine Green Fluorescence Angiography to Assess Tissue Perfusion Before Common Femoral Artery Aneurysm Ligation After Transfemoral Amputation

Introduction

The superiority of indocyanine green fluorescence angiography (ICG-FA) to the clinical eye alone to assess tissue perfusion has been demonstrated in various surgical fields. This short report demonstrates the in vivo use of ICG-FA to assess skin perfusion before ligating the external iliac artery (EIA) to exclude a common femoral artery (CFA) aneurysm.

Report

A 70-year-old man presented with a CFA aneurysm after a previous transfemoral amputation. Ligation of the EIA was proposed, but concerns about tissue perfusion warranted a careful approach. The CFA was exposed using an infra-inguinal incision. Intra-operative ICG inflow and washout patterns were semi-quantitatively analysed to assess dermal perfusion of the femoral stump before and after EIA clamping. Based on similar patterns, distal EIA ligation was performed without ischaemic complications.

Conclusion

Indocyanine green fluorescence angiography is a promising technique for in vivo assessment of tissue perfusion in peripheral arterial disease, but standardised protocols for perfusion quantification are required to more accurately predict tissue viability.