Near-infrared fluorescence imaging with indocyanine green in diabetic patient with critical limb ischemia: a case report

A case report of type 2 diabetic patient with critical limb ischemia (CLI) after successful endovascular revascularization is reported. The diagnosis of CLI was established according to clinical data and results of lower limb ischemia assessment by non-invasive methods. The unique feature of this case is presentation of results of the new method of lower limb ischemia assessment fluorescent angiography in near infrared range using indocyanine green (ICG). Following parameters of fluorescent angiography in near infrared range are analyzed in different regions of interest: Tstart(sec) the time of fluorescence occurrence (Istart, unit) in the analyzed area after intravenous administration of ICG; Tmax (sec) time to achieve maximum fluorescence (Imax, unit) after intravenous injection of ICG; Tmax Tstart (sec) the time difference between Imax and Istart. In this clinical case, the time of achievement Istart, Imax, Tmax Tstart in different regions of interest decreased after successful endovascular revascularization of lower limb arteries

Adrenal vein sampling in differential diagnosis of primary aldosteronism on the example of a clinical case

Primary aldosteronism is the most common cause of endocrine hypertension, occurring in 5–10% of patients with hypertension. Convincing evidence has been obtained indicating that primary aldosteronism increases the risk of cardiovascular complications, respectively, early diagnosis and treatment of patients with the definition of further tactics is a key step to prevent the progression of cardiovascular complications. The choice of the most appropriate treatment method for patients with primary aldosteronism depends on the diagnosis of nosological subtypes – bilateral adrenal hyperplasia (also known as idiopathic aldosteronism), which recommends a conservative treatment or unilateral aldosteronism due to aldosterone-producing adenoma, in which surgical treatment (adrenalectomy) is the tactic of choice. In addition, the "obvious" adrenal adenomas may in fact turn out to be areas of focal hyperplasia – a diagnostic error in this case leads to the unreasonable implementation of adrenalectomy. In order to clarify the lateralization of aldosterone hyperproduction, adrenal venous sampling is used. However, this method requires constant radiography, qualified endovascular surgery and is carried out in centralized medical hospitals. In this clinical case, we want to demonstrate the importance of a diagnosis of primary aldosteronism step by step