Evaluating the Role of Digital Subtraction Angiography in Traumatic Lower Extremity Flap Reconstruction: A Comparative Analysis With CT Angiography

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2025-05-01 DOI:10.1002/micr.70063

Artur Manasyan, Eloise W. Stanton, Erin Wolfe, Idean Roohani, Joseph N. Carey, David A. Daar

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引用次数: 0

Abstract

Background

Despite its high sensitivity and specificity, CTA can yield inconclusive or inaccurate results due to technical limitations such as metallic streak artifacts or inadequate opacification of arteries. On the other hand, digital subtraction angiography (DSA), a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels, stands as a gold standard for the assessment of arterial injuries, offering high-resolution and dynamic imaging.

Methods

Patients undergoing lower extremity reconstruction with a free flap at a Level 1 trauma center between 2015 and 2022 were retrospectively queried. Demographic data, details of arterial injuries assessed by CTA/DSA, flap and wound details, complications, and ambulatory outcomes were recorded. The study data were assessed and presented qualitatively.

Results

A total of 175 patients underwent microsurgical lower extremity reconstruction from 2015 to 2023, 98 (56.0%) of whom had CTA, and 14 (8.0%) underwent DSA preoperatively. The mean patient age was 47.1 ± 15.6 years, ranging from 21 to 68 years, with 10 (71.4%) males and four (28.6%) females. The most common indications for DSA were inconclusive CTA results of vessel runoff status (n = 6), evaluation of clinically suspected vascular injury not clearly delineated by CTA (n = 3), and artifact/streak due to orthopedic hardware (n = 2). DSA in six of the 14 cases revealed discrepancies with initial CTA findings, providing clarification on the location and extent of vascular injury preoperatively. Four of these patients experienced a change in surgical plan following formal angiography. There was no significant difference in postoperative flap complications (p = 0.189) or ambulation status (p = 0.074) between the DSA and CTA cohorts.

Conclusion

DSA effectively overcomes limitations encountered with CTA, such as issues related to hardware interference. In select patients where CTA limitations are significant, DSA might offer improved outcomes, highlighting the need for further research to validate these preliminary findings and better define the contexts in which DSA could be more beneficial.

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评价数字减影血管造影在创伤性下肢皮瓣重建中的作用：与CT血管造影的比较分析

尽管CTA具有高灵敏度和特异性，但由于技术限制，如金属条纹伪影或动脉不充分的混浊，CTA可能产生不确定或不准确的结果。另一方面，数字减影血管造影（DSA）是一种在介入放射学中广泛应用的血管可视化透视技术，它提供高分辨率和动态成像，是动脉损伤评估的金标准。方法回顾性分析2015 ~ 2022年在我院一级创伤中心行游离皮瓣下肢重建术的患者。记录人口统计数据、CTA/DSA评估的动脉损伤细节、皮瓣和伤口细节、并发症和门诊结果。对研究数据进行了定性评估和呈现。结果2015 - 2023年共175例患者行显微外科下肢重建术，术前行CTA 98例（56.0%），DSA 14例（8.0%）。患者平均年龄47.1±15.6岁，年龄21 ~ 68岁，男性10例（71.4%），女性4例（28.6%）。DSA最常见的适应症是CTA对血管径流状态的不确定结果（n = 6）， CTA未明确描述的临床可疑血管损伤评估（n = 3），以及矫形硬体造成的伪影/条纹（n = 2）。14例中有6例的DSA显示与最初的CTA结果不一致，从而澄清了术前血管损伤的位置和程度。其中4例患者在正式血管造影后改变了手术计划。DSA组和CTA组术后皮瓣并发症（p = 0.189）和活动状态（p = 0.074）无显著差异。结论DSA有效克服了CTA的局限性，如硬件干扰等问题。在CTA局限性明显的特定患者中，DSA可能提供更好的结果，强调需要进一步研究来验证这些初步发现，并更好地定义DSA可能更有益的背景。

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 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.