|2009 Annual Meeting Abstracts
CT Angiography in Planning Abdomen-based Microsurgical Breast Reconstruction: A Comparison to Duplex Ultrasound
Jeffrey R. Scott, MD, Daniel Liu, MD, Hakim Said, MD, Peter C. Neligan, MD, David W. Mathes, MD.
University of Washington, Seattle, WA, USA.
PURPOSE: In order to plan abdominal perforator-based microsurgical breast reconstruction, duplex ultrasound is often employed to pre-operatively identify abdominal wall blood vessel location. Recently, several groups have begun to favor computed tomography angiography (CTA) in place of duplex ultrasound for their pre-operative planning. It is unknown if the identification of abdominal wall perforators is enhanced with CTA. The purpose of this study is to identify whether clinically useful perforating vessels found on CTA correspond with perforating vessels found on duplex ultrasound.
METHODS: A prospective study of 23 patients undergoing 30 abdomen-based microsurgical breast reconstructions from August 2007-April 2008 with both preoperative CTA and duplex ultrasound studies. Median age was 51 years (+/-5.6). Thirty breast reconstructions were performed, including 4 muscle-sparing TRAM, 8 superficial inferior epigastric artery (SIEA), and 18 deep inferior epigastric perforator reconstructions. Perforator size and location were determined by both CTA and ultrasound data. The two largest perforators were chosen per abdominal side for comparison between studies. In addition, the locations of the pre-operatively identified perforators by both techniques were confirmed in the operating room.
RESULTS: CT Angiography pre-operatively identified 83 of the largest perforators. Duplex ultrasound only identified 55 (66%) of these large perforators. The remaining 28 perforators (33%) were not identified by ultrasound. The presence of perforators missed on ultrasound but identified on CTA was confirmed at the time of operation. No superficial inferior epigastric arteries were identified by ultrasound. Of the 8 reconstructions with the superficial inferior epigastric system, all 8 superficial inferior epigastric arteries were identified preoperatively as adequate size for microsurgical transfers by the surgeon or radiologist. One of eight SIEA flaps failed (12.5%), while the remainder of the flaps were successful (87.5%).
CONCLUSIONS: There are many distinct advantages to the use of preoperative CT angiography for planning abdominal perforator-based microsurgical breast reconstruction, including reliable and accurate identification of the superficial inferior epigastric artery. In addition, duplex ultrasound failed to identify 33% of the largest perforators in the deep inferior epigastric system. This study demonstrates the superiority of CT angiography over duplex ultrasound as a tool for pre-operative planning of perforator based breast reconstruction.