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Near-infrared fluorescence imaging with indocyanine green in diabetic patient with critical limb ischemia: a case report

https://doi.org/10.14341/DM9764

Abstract

A case report of type 2 diabetic patient with critical limb ischemia (CLI) after successful endovascular revascularization is reported. The diagnosis of CLI was established according to clinical data and results of lower limb ischemia assessment by non-invasive methods. The unique feature of this case is presentation of results of the new method of lower limb ischemia assessment – fluorescent angiography in near infrared range using indocyanine green (ICG). Following parameters of fluorescent angiography in near infrared range are analyzed in different regions of interest: Tstart(sec) – the time of fluorescence occurrence (Istart, unit) in the analyzed area after intravenous administration of ICG; Tmax (sec) – time to achieve maximum fluorescence (Imax, unit) after intravenous injection of ICG; Tmax – Tstart (sec) – the time difference between Imax and Istart. In this clinical case, the time of achievement Istart, Imax, Tmax – Tstart in different regions of interest decreased after successful endovascular revascularization of lower limb arteries.

About the Authors

Zera N. Dzhemilova
https://www.endocrincentr.ru/doctors/dzhemilova-abdulvapova-zera-nusredovna

Endocrinology Research Centre


Russian Federation

MD, research associate



Ivan I. Sitkin

Endocrinology Research Centre


Russian Federation

MD, PhD, senior research associate



Svetlana V. Sergeeva

Endocrinology Research Centre


Russian Federation

MD



Pavel V. Grachev

General Physics Institute of the Russian Academy of Sciences


Russian Federation

research associate



Kirill G. Linkov

General Physics Institute of the Russian Academy of Sciences


Russian Federation

PhD in Technology Sciences, senior research associate



Viktor B. Loshenov

General Physics Institute of the Russian Academy of Sciences


Russian Federation

MD, PhD, Professor



Gagik R. Galstyan

Endocrinology Research Centre


Russian Federation

MD, PhD, Professor



References

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Supplementary files

1. Fig. 1. Dynamics of clinical changes and interventional interventions on the left lower limb of patient B.
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2. Fig. 2. The result of fluorescent angiography (FAG) in the near infrared range (BID) of the left foot. A - view of the foot at the time of the study. B - view of the foot during the FAG in the BID. Areas of evaluation of the parameters of PAG in BID: 0 - the region of minimal fluorescence; 1 - area of ​​maximum fluorescence; 2 - region of the 1st interdigital gap; 3 - area of ​​study of the majority of the foot. B - diagram of FAG in BID in the zones of interest 0–3. Tstart (s) - the time of appearance of fluorescence (Istart, unit) in the study area after intravenous administration of indocyanine green (ICG); Tmax (s) is the time to reach maximum fluorescence (Imax, unit) after intravenous administration of ICG; Tmax-Tstart (s) - the difference in time to reach Imax and Istart.
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3. Fig. 3. Result of diagnostic subtraction angiography of patient B., 69 years old, with diabetes mellitus and critical lower limb ischemia. Occlusions were revealed in the distal segment of the popliteal artery (PoA); occlusion of the tibioperoneal trunk (TPS), fibular artery (IBA), posterior tibial artery (ABBA), anterior tibial artery (PBBA).
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4. Fig. 4. The result of percutaneous transluminal balloon angioplasty and stenting of the popliteal artery (PoA), balloon angioplasty of the anterior tibial artery (PBBA) throughout, including the plantar arterial arch. TAS - dorsal artery of the foot.
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5. Fig. 5. The result of the parameters of fluorescent angiography (PAGE) in the near infrared range (BID) of the left foot in the postoperative period. A - view of the foot at the time of the study. B - view of the foot in the process of conducting FAG in the BID. Areas of evaluation of the parameters of PAG in BID: 0 - the region of minimal fluorescence; 1 - area of ​​maximum fluorescence; 2 - area of ​​the 1st interdigital gap, 3 - area of ​​study of the greater part of the foot. B - diagram of FAG in BID in the zones of interest 0–3. Tstart (s) - the time of appearance of fluorescence (Istart, unit) of the study area after intravenous administration of indocyanine green (ICG); Tmax (s) is the time to reach maximum fluorescence (Imax, unit) after intravenous administration of ICG; Tmax –Tstart (s) - time difference reaching Imax and Istart
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Review

For citations:


Dzhemilova Z.N., Sitkin I.I., Sergeeva S.V., Grachev P.V., Linkov K.G., Loshenov V.B., Galstyan G.R. Near-infrared fluorescence imaging with indocyanine green in diabetic patient with critical limb ischemia: a case report. Diabetes mellitus. 2018;21(4):319-324. (In Russ.) https://doi.org/10.14341/DM9764

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ISSN 2072-0351 (Print)
ISSN 2072-0378 (Online)