Fluorescence imaging for assessing tissue perfusion after revascularization in peripheral arterial disease

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.