The Ability of ICG Fluorescence Angiography to Facilitate Accurate Diagnosis in Difficult or Previously Unidentified Wound Pathologies

Background: Patients are referred to Centers of Excellence when community providers of care are unable to resolve perceived diagnoses that do not respond to normal standard of care. Autoimmune disorders alone have more than 80 different sub diagnoses and affect more than 50 million Americans. Frequently, patients present with acute, repetitive, or chronic wounds that have been inaccurately diagnosed and undertreated. These diseases afflict blood vessels, connective tissue, and organ function with inflammatory exacerbations that are unpredictable and difficult to control, affecting microcirculation and healing abilities.

Methods: The use of ICG Fluorescence Angiography (ICGFA) allows the physician specialist the ability to assess perfusion and degrees of inflammation with a real time view and measurement of arterial flow, venous return, and degree of inflammation at any selected area of pathology. Serially, this provides a comprehensive tool to measure actual tissue and vessel environments effects of ongoing treatment plans. Patients who are referred to this large urban wound center who have not responded to standard of care are often provided with ICGFA to identify inflammatory conditions and assist the expert clinician to visualize the need for medications, diagnostics, interventions and consultations.

Results: This simple inexpensive study has promoted the ability to accurately define and measure the outcomes of selected treatment pathways. It allows accurate timing of application of biological tissues and therapeutic injections, including botox for microvascular complications. It also predicts the expected outcome for the use of hyperbaric oxygen as adjunctive therapy to promote rapid positive outcomes or to discontinue expensive therapies if no measurable outcome is obtained in a timely manner. ICGFA has promoted a change in physician practice in keeping with the current environment of pay for quality, not for quantity.

Conclusion: This tool has enhanced patient engagement and a high degree of patient trust and satisfaction in all aspects of decision making.