Indocyanine green video angiography predicts outcome of extravasation injuries

Abstract

Background: Extravasation of cytotoxic drugs is a serious complication of systemic cancer treatment. Still, a reliable method for early assessment of tissue damage and outcome prediction is missing. Here, we demonstrate that the evaluation of blood flow by indocyanine green (ICG) angiography in the extravasation area predicts for the need of surgical intervention.

Methods: Twenty-nine patients were evaluated by ICG angiography after extravasation of vesicant or highly irritant cytotoxic drugs administered by peripheral i.v. infusion. Tissue perfusion as assessed by this standardized method was correlated with clinical outcome.

Results: The perfusion index at the site of extravasation differed significantly between patients with reversible tissue damage and thus healing under conservative management (N = 22) versus those who needed surgical intervention due to the development of necrosis (N = 7; P = 0.0001). Furthermore, in patients benefiting from conservative management, the perfusion index was significantly higher in the central extravasation area denoting hyperemia, when compared with the peripheral area (P = 0.0001).

Conclusions: In this patient cohort, ICG angiography as indicator of local perfusion within the extravasation area was of prognostic value for tissue damage. ICG angiography could thus be used for the early identification of patients at risk for irreversible tissue damage after extravasation of cytotoxic drugs.

Figure 1. Perfusion at central area (A) and peripheral area (B) of the extravasation lesion.

Box plots represent cutaneous blood flow as assessed by the perfusion index in patients with conservative clinical management (N = 22) versus those requiring subsequently surgical intervention (N = 7); *statistical significance p<0.05.

Figure 2. Perfusion in patients not requiring surgery: central area versus peripheral area of the extravasation lesion.

Box plots represent cutaneous blood flow as assessed by the perfusion index in patients relying on conservative clinical management (N = 22).

Figure 3. Perfusion in patients requiring surgery: central area versus peripheral area of the extravasation lesion.

Box plots represent cutaneous blood flow as assessed by the perfusion index in patients requiring surgical intervention after extravasation of cytotoxics (N = 7); *statistical significance p<0.05.