Annals of vascular surgery, 6 1 2025, Pages S0890-5096(25)00655-7 Prediction of wound healing following amputation surgery based on near-infrared fluorescence with indocyanine green. Kruiswijk MW, Peul RC, Tange FP, Koning S, van der Aa LE, Eefting D, van der Bogt KEA, van den Hoven P, van der Vorst JR, Vascular Fluorescence group
Objectives
The objective of this study was to evaluate the predictive value of near-infrared (NIR) fluorescence imaging with indocyanine on wound-healing complications within six weeks after lower-extremity amputation.
Methods
In this dual-centre cohort study, patients undergoing minor (below-ankle) or major (above-ankle) amputations due to PAD or diabetes mellitus, with perfusion assessment performed using ICG NIR fluorescence imaging, were included. Fluorescence videos were recorded using standardised protocols following intravenous administration of 0.1 mg/kg ICG. The fluorescence pattern and clinical perfusion were assessed intraoperatively as normal, questionable, or poor.
Results
A total of 63 patients undergoing 85 amputations were included, with a near-equal distribution of minor (51%) and major (49%) procedures. Within the entire cohort, the sensitivity of a poor fluorescence pattern on wound healing complications was 46%, specificity 90%, with a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 55%. In the major amputation group, a significant correlation was observed between the fluorescence pattern and the occurrence of necrosis (p=.008) as well as minor and major complications (p=.049; p=.013). Poor fluorescence patterns were significantly correlated with the occurrence of major complications following minor amputations (p=.027). In 57% (n=12) of patients with a poor fluorescence pattern, the vascular surgeon assessed the clinical perfusion as good.
Conclusion
Poor perfusion observed with ICG NIR fluorescence imaging can predict wound healing complications following lower extremity amputation. A difference was observed between the predictive values of minor and major amputations, with the positive predictive value being considerably higher for minor amputations than for major amputations. Clinical assessment of perfusion was inferior to ICG NIR fluorescence in detecting patients at risk.
