Preoperative Vascular Imaging in Lower Extremity Free Flap Reconstruction: Comparison Between Imaging Modalities

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-09-20 DOI:10.1002/micr.31241
Leah Ahn, Joani M. Christensen, Seth Fruge, Mara Z. Meulendijks, Yannick Albert J. Hoftiezer, Frankie K. Wong, Krystle R. Tuano, Ian L. Valerio, Kyle R. Eberlin
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引用次数: 0

Abstract

Background

Adequate vascular anatomy and perfusion status are essential for successful lower extremity free tissue transfer. Computed tomography angiography (CTA) is widely available, minimally invasive, and enables visualization of soft tissues and bones. Angiography permits temporal evaluation of flow, identifies potential needs for concurrent endovascular interventions, and enhances visibility in the setting of hardware. Despite widespread availability of these imaging modalities, no standardized algorithm for preoperative imaging prior to lower extremity free flap reconstruction exists.

Methods

Current Procedural Terminology (CPT) codes identified patients undergoing free flap reconstruction of the lower extremity over an 18-year period (2002–2020). Electronic medical records were reviewed for patient, treatment, and imaging characteristics, and pre- and post-imaging laboratory values. Outcomes included imaging findings and related complications and surgical outcomes.

Results

In total, 405 patients were identified, with 59% (n = 238) undergoing preoperative imaging with angiography, 10% (n = 42) with CTA, 7.2% (n = 29) with both imaging modalities, and 24% (n = 96) with neither performed. Forty percent (122 of 309) of patients who underwent preoperative imaging had less than 3-vessel runoff. Four patients developed contrast-induced nephropathy (CIN) after angiography only and one after having both CTA and angiography. Vessel runoff on CTA and angiography demonstrated moderate correlation.

Conclusion

Most patients undergoing lower extremity free tissue transfer underwent preoperative imaging with angiography and/or CTA, 40% of which had less than 3-vessel runoff. Both angiography and CTA had low complication rates, with no statistically significant risk factors identified. Specifically, the incidence of CIN was not found to be significant using either modality. We discuss our institutional algorithm to aid in decision-making for preoperative imaging prior to lower extremity free flap reconstruction. Specifically, we recommend angiography for patients with peripheral vascular disease, internal hardware, or distal defects secondary to trauma.

下肢游离皮瓣重建术前血管成像:不同成像模式的比较
背景 充分的血管解剖和灌注状态对成功进行下肢游离组织转移至关重要。计算机断层扫描血管造影术(CTA)应用广泛,创伤小,可观察软组织和骨骼。血管造影可对血流进行时间评估,确定同时进行血管内介入治疗的潜在需求,并提高硬件设置的可视性。尽管这些成像模式已广泛应用,但目前还没有下肢游离皮瓣重建术前成像的标准化算法。 方法 对 18 年内(2002-2020 年)接受下肢游离皮瓣重建术的患者进行当前程序术语(CPT)代码识别。对电子病历进行了审查,以了解患者、治疗和成像特征以及成像前后的实验室值。结果包括成像结果、相关并发症和手术结果。 结果 共确定了 405 名患者,其中 59%(n = 238)的患者在术前接受了血管造影成像,10%(n = 42)的患者接受了 CTA,7.2%(n = 29)的患者同时接受了两种成像方式,24%(n = 96)的患者两种成像方式都没有进行。在接受术前成像的患者中,40%(309 例中的 122 例)的血管径流少于 3 条。四名患者仅在血管造影后出现造影剂诱发肾病 (CIN),一名患者在同时进行 CTA 和血管造影后出现造影剂诱发肾病 (CIN)。CTA 和血管造影的血管径流显示出中等相关性。 结论 大多数接受下肢游离组织转移的患者在术前都接受了血管造影和/或 CTA 检查,其中 40% 的患者血管径流少于 3 条。血管造影和 CTA 的并发症发生率都很低,没有发现有统计学意义的风险因素。具体而言,两种方式的CIN发生率都不高。我们讨论了本机构在下肢游离皮瓣重建术前成像的辅助决策算法。具体来说,我们建议患有外周血管疾病、内部硬件或因外伤继发远端缺损的患者进行血管造影。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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