Comparison of ICG Microangiography and Conventional Angiography in Severe Frostbite

NCT05777590 | Active Not Recruiting FDA Drug

• 1 other identifier: A22-321
• Study Type: observational
• Target: 8
• Locations: 1 country
• Sites: 1

Brief Summary

Severe frostbite injury is a significant cause of morbidity in northern climates. Minnesota has some of the highest numbers of severe frostbite injuries in North America. As a result, Regions Hospital has the best opportunity to study this disease process and improve outcomes for frostbite patients. The diagnostic methods for severe frostbite injury vary from institution to institution and there is no standard practice. Commonly utilized methods include conventional angiography, Technetium 99 triple phase bone scans, SPECT studies, Indocyanine Green microangiography, and doppler studies. The proposed pilot study aims to directly compare conventional angiography imaging to ICG microangiography in adult patients with severe frostbite. Severe frostbite is defined as 4th degree: frostbite resulting in vascular occlusion and tissue ischemia. Both imaging modalities have been used for the diagnosis and monitoring of severe frostbite injury but there has never been a study directly comparing these two imaging modalities.

Conditions

Frostbite

Keywords

Frostbite; Angiogram; Indocyanine Green; ICG

Outcome Measures

Primary Outcomes (1)

• Assessment of Angiography and ICG microangiography imaging demonstrating ischemic tissue present in severe frostbite scored by Hennepin Frostbite Score.

  Hypothesize that these two imaging modalities (ICG (indocyanine green) and conventional angiography) will be concordant at demonstrating the ischemic tissue present in severe frostbite.

  Through study completion, an average of 2 years

Secondary Outcomes (1)

• Safety of indocyanine green when delivered in close association with contrast dye (used in conventional angiography) measured by number of adverse events

  Through study completion, an average of 2 years

Interventions

Indocyanine Green Angiogram DRUG

Angiogram using ICG dye the occurs directly after conventional angiogram in assessment of frostbite patients undergoing thrombolysis

Also known as: ICG

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients undergoing conventional angiography and thrombolysis for severe frostbite. will be identified by the burn surgeons and advance practice practitioners. They will evaluate the patients to determine whether they meet the inclusion/exclusion criteria of the study.

You may qualify if:

• Adult (\>18 years old) patients
• Diagnosed with severe frostbite by conventional angiography
• Undergoing thrombolysis with catheter directed lytics
• Clinically sober at the time of consent
• Cognitively able to provide consent as determined by clinician's best judgement
• Normal kidney function (GFR \>60)

You may not qualify if:

• Pregnant. Pregnancy will be determined by standard of care pregnancy test performed on all female frostbite patients who are receiving lytics.
• Iodine allergy.

Sponsors & Collaborators

• HealthPartners Institute: lead

Study Sites (1)

Regions Hospital

Saint Paul, Minnesota, 55101, United States

Location

Related Publications (19)

• Lacey AM, Rogers C, Endorf FW, Fey RM, Gayken JR, Schmitz KR, Punjabi GV, Whitley AB, Masters TC, Moore JC, Nygaard RM. An Institutional Protocol for the Treatment of Severe Frostbite Injury-A 6-Year Retrospective Analysis. J Burn Care Res. 2021 Aug 4;42(4):817-820. doi: 10.1093/jbcr/irab008.

  PMID: 33484248 BACKGROUND

• Gonzaga T, Jenabzadeh K, Anderson CP, Mohr WJ, Endorf FW, Ahrenholz DH. Use of Intra-arterial Thrombolytic Therapy for Acute Treatment of Frostbite in 62 Patients with Review of Thrombolytic Therapy in Frostbite. J Burn Care Res. 2016 Jul-Aug;37(4):e323-34. doi: 10.1097/BCR.0000000000000245.

  PMID: 25950290 BACKGROUND

• Gao Y, Wang F, Zhou W, Pan S. Research progress in the pathogenic mechanisms and imaging of severe frostbite. Eur J Radiol. 2021 Apr;137:109605. doi: 10.1016/j.ejrad.2021.109605. Epub 2021 Feb 17.

  PMID: 33621855 BACKGROUND

• Millet JD, Brown RK, Levi B, Kraft CT, Jacobson JA, Gross MD, Wong KK. Frostbite: Spectrum of Imaging Findings and Guidelines for Management. Radiographics. 2016 Nov-Dec;36(7):2154-2169. doi: 10.1148/rg.2016160045. Epub 2016 Aug 5.

  PMID: 27494386 BACKGROUND

• Twomey JA, Peltier GL, Zera RT. An open-label study to evaluate the safety and efficacy of tissue plasminogen activator in treatment of severe frostbite. J Trauma. 2005 Dec;59(6):1350-4; discussion 1354-5. doi: 10.1097/01.ta.0000195517.50778.2e.

  PMID: 16394908 BACKGROUND

• Heard J, Shamrock A, Galet C, Pape KO, Laroia S, Wibbenmeyer L. Thrombolytic Use in Management of Frostbite Injuries: Eight Year Retrospective Review at a Single Institution. J Burn Care Res. 2020 May 2;41(3):722-726. doi: 10.1093/jbcr/iraa028.

  PMID: 32030427 BACKGROUND

• Masters T, Omodt S, Gayken J, Logue C, Westgard B, Hendriksen S, Walter J, Nygaard R. Microangiography to Monitor Treatment Outcomes Following Severe Frostbite Injury to the Hands. J Burn Care Res. 2018 Jan 1;39(1):162-167. doi: 10.1097/BCR.0000000000000526.

  PMID: 28328661 BACKGROUND

• Lacey AM, Fey RM, Gayken JR, Endorf FW, Schmitz KR, Punjabi GV, Masters TC, Nygaard RM. Microangiography: An Alternative Tool for Assessing Severe Frostbite Injury. J Burn Care Res. 2019 Aug 14;40(5):566-569. doi: 10.1093/jbcr/irz112.

  PMID: 31298700 BACKGROUND

• WEATHERLEY-WHITE RC, SJOSTROM B, PATON BC. EXPERIMENTAL STUDIES IN COLD INJURY. II. THE PATHOGENESIS OF FROSTBITE. J Surg Res. 1964 Jan;4:17-22. doi: 10.1016/s0022-4804(64)80004-4. No abstract available.

  PMID: 14106388 BACKGROUND

• Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med. 1992 Oct;20(10):1402-5. doi: 10.1097/00003246-199210000-00007.

  PMID: 1395660 BACKGROUND

• Zook N, Hussmann J, Brown R, Russell R, Kucan J, Roth A, Suchy H. Microcirculatory studies of frostbite injury. Ann Plast Surg. 1998 Mar;40(3):246-53; discussion 254-5. doi: 10.1097/00000637-199803000-00009.

  PMID: 9523607 BACKGROUND

• Bourne MH, Piepkorn MW, Clayton F, Leonard LG. Analysis of microvascular changes in frostbite injury. J Surg Res. 1986 Jan;40(1):26-35. doi: 10.1016/0022-4804(86)90141-1.

  PMID: 3941548 BACKGROUND

• Robson MC, Heggers JP. Evaluation of hand frostbite blister fluid as a clue to pathogenesis. J Hand Surg Am. 1981 Jan;6(1):43-7. doi: 10.1016/s0363-5023(81)80010-x.

  PMID: 7204918 BACKGROUND

• McCauley RL, Hing DN, Robson MC, Heggers JP. Frostbite injuries: a rational approach based on the pathophysiology. J Trauma. 1983 Feb;23(2):143-7.

  PMID: 6827634 BACKGROUND

• Rogers C, Lacey AM, Endorf FW, Punjabi G, Whitley A, Gayken J, Fey R, Schmitz K, Nygaard RM. The Effects of Rapid Rewarming on Tissue Salvage in Severe Frostbite Injury. J Burn Care Res. 2022 Jul 1;43(4):906-911. doi: 10.1093/jbcr/irab218.

  PMID: 34791315 BACKGROUND

• Braun JD, Trinidad-Hernandez M, Perry D, Armstrong DG, Mills JL Sr. Early quantitative evaluation of indocyanine green angiography in patients with critical limb ischemia. J Vasc Surg. 2013 May;57(5):1213-8. doi: 10.1016/j.jvs.2012.10.113. Epub 2013 Jan 24.

  PMID: 23352361 BACKGROUND

• Jafari MD, Lee KH, Halabi WJ, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc. 2013 Aug;27(8):3003-8. doi: 10.1007/s00464-013-2832-8. Epub 2013 Feb 13.

  PMID: 23404152 BACKGROUND

• Zhi Z, Yin X, Dziennis S, Wietecha T, Hudkins KL, Alpers CE, Wang RK. Optical microangiography of retina and choroid and measurement of total retinal blood flow in mice. Biomed Opt Express. 2012 Nov 1;3(11):2976-86. doi: 10.1364/BOE.3.002976. Epub 2012 Oct 24.

  PMID: 23162733 BACKGROUND

• Nygaard RM, Whitley AB, Fey RM, Wagner AL. The Hennepin Score: Quantification of Frostbite Management Efficacy. J Burn Care Res. 2016 Jul-Aug;37(4):e317-22. doi: 10.1097/BCR.0000000000000277.

  PMID: 26536540 BACKGROUND

MeSH Terms

Conditions

Frostbite

Condition Hierarchy (Ancestors)

Cold Injury; Wounds and Injuries

Study Officials

• Alexandra Lacey, MD

  Regions Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 14, 2023
• First Posted: March 21, 2023
• Study Start: February 3, 2023
• Primary Completion: February 1, 2025
• Study Completion (Estimated): May 30, 2026
• Last Updated: January 6, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)