Background: Preoperative angiography is a useful adjunct to microsurgical reconstruction. 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: Twenty-three CT angiograms were obtained in 19 patients undergoing microsurgical reconstruction of the head and neck, lower extremity or upper extremity. Average patient age was 46.9 years. An analysis of charges related to the CT procedure were compared to conventional preoperative imaging.

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, average CT angiogram charge was $1,140 and $3,900 for traditional angiography.

Conclusion: CT was $15,000. angiography provides high resolution, three dimensional arterial, venous and soft tissue imaging without the risks of traditional angiogram at a significantly lower cost. CT angiography may provide a favorable alternative to traditional angiography prior to microsurgical reconstruction.