Is There an Indication for Digital Subtraction Angiography in the Assessment of Irradiation-Induced Vascular Damage before Free Flap Surgery by the Means of the Internal Mammary Vessels?

Steven Klein; Saske Hoving; Paul Werker; Nicola Russell

doi:10.1055/s-0033-1351667

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2014; 30(01): 047-052
DOI: 10.1055/s-0033-1351667

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is There an Indication for Digital Subtraction Angiography in the Assessment of Irradiation-Induced Vascular Damage before Free Flap Surgery by the Means of the Internal Mammary Vessels?

Authors

Steven Klein

¹Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, The Netherlands
Saske Hoving

²Department of Biological Stress Response, The Dutch Cancer Institute, Amsterdam, The Netherlands
Paul Werker

¹Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, Groningen, The Netherlands
Nicola Russell

³Department of Radiotherapy, The Dutch Cancer Institute, Amsterdam, The Netherlands

Abstract

Secondary breast reconstruction is increasingly performed after postmastectomy radiotherapy. Damage to blood vessel walls is one of the adverse effects of irradiation therapy, which may jeopardize reconstructive free flap surgery. It would be of great importance to be informed about the quality of the recipient vessel before reconstructive surgery. The aim of this study was to prospectively assess the value of preoperative angiography in the assessment of radiation-induced arterial damage and to relate the findings to the degree of vascular damage found during the operation and with histology. This study included women who had been treated with thoracic radiotherapy and required free flap breast reconstruction. Preoperative angiographic, intraoperative quality and histological findings of vessels were scored and compared together with the occurrence of postoperative complications. In 34 patients a total of 40 free flaps breast reconstruction were performed. Total 21 internal mammary arteries had been within the field of irradiation. In only two out of six patients with aberrant angiographies the internal mammary artery has been within the field of irradiation. This study concludes that damage to the internal mammary vessels cannot always be detected preoperatively by angiography, or even by intraoperative examination.

Keywords

free flap - digital subtraction angiography - histology - internal mammary artery

Full Text

References

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