Assessment of foot perfusion before and after revascularization using quantitative ICG near-infrared fluorescence imaging in patients with and without diabetes mellitus

Diabetes Mellitus(DM) complicates peripheral artery disease (PAD) by increasing neuropathy, ischemia, and amputation risk. Perfusion differences between PAD patients with and without diabetes may support more personalized revascularization strategies than current WIfI-based prediction using the Society for Vascular Surgery classification system. This study evaluated the ability of quantitative near-infrared fluorescence imaging with Indocyanine Green (ICG) to detect differences in tissue perfusion response following revascularization between PAD patients with and without diabetes and explore their relationship with short-term clinical outcomes. ICG near-infrared fluorescence imaging was performed pre- and post-revascularization in PAD patients with and without diabetes. Three time-based perfusion parameters were analyzed. Clinical improvement was assessed in patients with chronic limb-threatening ischaemia (CLTI) at the six-week follow-up. Successful revascularization and imaging were conducted in 128 patients (144 limbs), including 42 (32.8%) DM patients (48 limbs). Overall, 67 patients had CLTI (24 DM, 43 non-DM). Of these, 50 had clinical improvement (16 DM, 34 non-DM), while 14 did not (8 DM, 6 non-DM), 3 were lost to follow-up. Preoperatively, DM patients showed faster in- and outflow than non-DM patients, except at the crural level. Postoperatively, 2 of 9 perfusion parameters improved in the DM group ( p < 0.001), versus 6 of 9 in the non-DM group ( p = 0.027–<0.001). Among CLTI patients with clinical improvement, perfusion significantly improved across all parameters in non-DM patients ( p = 0.08–<0.001), but not in DM patients. A trend toward lower clinical improvement likelihood was observed in DM CLTI patients (66% vs. 85%, p = 0.073). ICG near-infrared fluorescence imaging captures disparities in dynamic foot perfusion between DM and non-DM PAD patients. While revascularization improves perfusion in both, non-DM patients show greater physiological and clinical benefit. DM CLTI patients demonstrate reduced responsiveness, underscoring the value of near-infrared fluorescence imaging and the need for tailored strategies in this high-risk group. Not applicable.