Methods for assessing peripheral arterial disease (PAD) include ankle-brachial index (ABI) and transcutaneous oxygen pressure (TcPO2) measurements. Fluorescence imaging with indocyanine green (FI) has been proposed as a promising tool for tissue perfusion assessment, despite lack of robust evidence due to small study cohorts or missing comparison of methods. In this prospective study, patients underwent FI, TcPO2, and ABI measurements before and after revascularization. FI quantification included slope of fluorescence intensity (SFI), background-subtracted peak fluorescence intensity (BSFI), and time to peak (TTP). The primary objective was to assess FI-derived metrics compared to ABI and TcPO2 after successful revascularization. Out of 95 patients 67% showed improved perfusion in FI after revascularization. Worsened perfusion was observed in 18% of patients, characterized by reduced SFI and BSFI and prolonged TTP, while no significant changes were seen in patients with unchanged perfusion. FI-derived parameters showed no correlation with ABI, TcPO2, or clinical outcomes. FI did not reliably detect perfusion improvement despite successful revascularization and showed no association with clinical outcomes or established measures. In contrast, TcPO2 demonstrated a strong correlation with clinical results. These findings question the reliability of FI for post-procedural perfusion assessment and suggest inferiority compared with TcPO2.
Kluckner et al. (Fri,) studied this question.