Evaluation of Lower-Limb Arteries with Multidetector Computed Tomography Angiography Prior to Free Flap Surgery: A Radioanatomic Study

ABSTRACT

In this study, we aimed to evaluate the vascular structures of the lower limb with multidetector computed tomography (CT) angiography and to reveal the importance of this method in preoperative planning of microsurgical transplantation. In 24 patients, lower-limb arteries were bilaterally evaluated with 16-detector spiral CT scanner in terms of patency, stenosis, or occlusion; maximal and minimal external diameters through their traces; and variations as well as length of the peroneal artery. The peroneal artery was absent unilaterally in two patients (4.3%). The mean maximal and minimal diameters were as 2.77 and 1.63, 2.92 and 1.75, and 2.72 and 1.50 mm for anterior and posterior tibial and peroneal arteries, respectively. The ranges of lengths of peroneal arteries were 50 to 117 mm. This valuable tool can provide detailed information about vascular and the remaining anatomic structures by means of its high-resolution characteristics before planning free flap surgery.

Angiography - computed tomography - flap - lower limb - vessel

REFERENCES

• 1 Nahabedian M Y, Singh N, Deune E G, Silverman R, Tufaro A P. Recipient vessel analysis for microvascular reconstruction of the head and neck.  Ann Plast Surg. 2004;  52 148-155 discussion 156-157
• 2 Nahabedian M Y, Momen B, Manson P N. Factors associated with anastomotic failure after microvascular reconstruction of the breast.  Plast Reconstr Surg. 2004;  114 74-82
• 3 Carroll W R, Esclamado R. Preoperative vascular imaging for the fibular osteocutaneous flap.  Arch Otolaryngol Head Neck Surg. 1996;  122 708-712
• 4 Kadir S, ed. Atlas of Normal and Variant Angiographic Anatomy. Philadelphia: Saunders; 1991
• 5 Lippert H, Pabst R. Arterial Variations in Man—Classification and Frequency. Munich, Germany: Verlag; 1985
• 6 Whitley S P, Sandhu S, Cardozo A. Preoperative vascular assessment of the lower limb for harvest of a fibular flap: the views of vascular surgeons in the United Kingdom.  Br J Oral Maxillofac Surg. 2004;  42 307-310
• 7 Blackwell K E. Donor site evaluation for fibula free flap transfer.  Am J Otolaryngol. 1998;  19 89-95
• 8 Lutz B S, Wei F C, Machens H G, Rhode U, Berger A. Indications and limitations of angiography before free-flap transplantation to the distal lower leg after trauma: prospective study in 36 patients.  J Reconstr Microsurg. 2000;  16 187-191 discussion 192
• 9 Busch H P, Hoffmann H G, Metzner C, Oettinger W. [MR angiography of the lower extremities with an automatic table translation (Mobitrak) compared to i.a. DSA].  Rofo. 1999;  170 275-283
• 10 Kreitner K F, Kalden P, Neufang A et al.. Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography.  AJR Am J Roentgenol. 2000;  174 171-179
• 11 Oliver T B, Lammie G A, Wright A R et al.. Atherosclerotic plaque at the carotid bifurcation: CT angiographic appearance with histopathologic correlation.  AJNR Am J Neuroradiol. 1999;  20 897-901
• 12 Mast B A. Comparison of magnetic resonance angiography and digital subtraction angiography for visualization of lower extremity arteries.  Ann Plast Surg. 2001;  46 261-264
• 13 Lorenz R R, Esclamado R. Preoperative magnetic resonance angiography in fibular-free flap reconstruction of head and neck defects.  Head Neck. 2001;  23 844-850
• 14 Rubin G D, Shiau M C, Leung A N, Kee S T, Logan L J, Sofilos M C. Aorta and iliac arteries: single versus multiple detector-row helical CT angiography.  Radiology. 2000;  215 670-676
• 15 Wintermark M, Uske A, Chalaron M et al.. Multislice computerized tomography angiography in the evaluation of intracranial aneurysms: a comparison with intraarterial digital subtraction angiography.  J Neurosurg. 2003;  98 828-836
• 16 Masia J, Clavero J A, Larrañaga J R, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps.  J Plast Reconstr Aesthet Surg. 2006;  59 594-599
• 17 Alonso-Burgos A, García-Tutor E, Bastarrika G, Cano D, Martínez-Cuesta A, Pina L J. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience.  J Plast Reconstr Aesthet Surg. 2006;  59 585-593
• 18 Tan O, Kantarci M, Parmaksizoglu D, Uyanik U, Durur I. Determination of the recipient vessels in the head and neck using multislice spiral computed tomography angiography before free flap surgery: a preliminary study.  J Craniofac Surg. 2007;  18 1284-1289
• 19 Chow L C, Napoli A, Klein M B, Chang J, Rubin G D. Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation.  Radiology. 2005;  237 353-360