Background: Preoperative angiography has become a standard component of microsurgical reconstruction planning. However, there are several potentially devastating complications from angiography including arterial occlusion and pseudoaneurysm . Computed tomographic (CT) angiography is a relatively new technique capable of providing detailed information about vascular anatomy as well as soft and bony tissue without the risks of traditional angiography . In addition, three dimensional image reconstruction uniquely demonstrates anatomic relationships between blood vessels, bones, and soft tissue.

Methods: Fourteen CT angiograms were obtained in patients referred for microsurgical reconstruction of the head and neck, lower extremity or upper extremity. Average patient age was 46.9 years (range 22 – 67). Three dimensional image reconstruction was performed on all studies. All studies were interpreted by a single staff radiologist with expertise in CT angiography. An analysis of charges related to the CT procedure were compared to conventional preoperative imaging for microsurgical repair.

Results: When compared to intraoperative evaluation, CT angiograms demonstrated all clinically relevant surgical anatomy. There were no complications of the radiographic procedure and no complications following free flap reconstruction. At our institution, the average CT angiogram charge was $1900, a fraction of the cost for traditional angiography.

Conclusion: CT angiography provides high resolution, three dimensional arterial, venous and soft tissue imaging without the risks of traditional angiogram at a significantly lower cost.