title: Use of indigo carmine angiography to qualitatively assess adequate distal perfusion after endovascular revascularization in critical limb ischemia.
abstract: OBJECTIVE
  To report a novel technique to visualize the efficacy of revascularization in critical limb ischemia patients with ischemic foot ulcers.
  
  
  METHODS
  An 80-year-old man was admitted with nonhealing ulcers on his left second toe and lateral border of the foot owing to in-stent restenosis of the left popliteal artery. After dilation of the popliteal in-stent restenosis, below-the-knee angiography revealed that the anterior tibial artery (ATA) was occluded, the posterior tibial artery was hypoplastic, and the peroneal artery was enlarged, with 2 plantar arteries. To evaluate the foot circulation before performing additional procedures, a 4-F multipurpose catheter was advanced into the peroneal artery, and 5 mL of indigo carmine was injected. Immediately, the patient's second toe and lateral border ulcers were dyed blue. We concluded that sufficient blood flow had been obtained to the ulcerated area by balloon angioplasty alone, so the procedure was terminated. The ulcers completely healed at 1 month.
  
  
  CONCLUSIONS
  Indigo carmine angiography provides visual information on foot perfusion, yielding new insights into microcirculation and helping to determine the effectiveness of treatment and procedure endpoint.
authors.affiliation: Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan akihiro.higashimori@tokushukai.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashimori
authors.affiliation: Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity; D004396:Coloring Agents / Q000008:administration & dosage*; D016638:Critical Illness; D017719:Diabetic Foot / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007203:Indigo Carmine / Q000008:administration & dosage*; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D004396:Coloring Agents; D007203:Indigo Carmine
keywords: angiography; balloon angioplasty; critical limb ischemia; dye; endovascular repair; indigo carmine; occlusion; revascularization; ulcer