Purpose: Computed Tomography Angiography (CTA) is a non-invasive method of obtaining three-dimensional vascular maps as well as soft-tissue definition. The goal of this study was to evaluate the reliability, usefulness and pitfalls of CTA in the planning of microvascular reconstruction.
Methods: We retrospectively reviewed all CT Angiograms performed on patients who underwent microsurgical reconstruction between 2001 and 2005 after obtaining IRB approval. The effect of the CTA results on the operative plan was assessed for each patient, and the CTA results were compared to the operative findings when possible. All technical difficulties and flap related complications were reported.
Results: 94 patients met our selection criteria. CTA studies were performed while planning reconstruction of the lower extremity (36%), head and neck (27%), upper extremity (22%), breast / chest wall (14%), and abdomen (1%). CTA was mainly performed at the recipient site (79%). The main indications for donor site CTA were breast reconstruction after radiation / axillary dissection and free fibula transfer in patients with clinical evidence or risk factors for peripheral vascular disease. 48 (51%) of the CTA studies showed some abnormality. CTA results were in good agreement with operative findings (positive correlation in 95% of cases). An abnormal CTA caused a change of operative plan in 34 patients. Changes were made in the choice of recipient / donor vessels, the side of graft harvest, or the nature of the reconstruction (local flap. vs. free tissue transfer). Technical difficulties in performing CTA were encountered in only 5 patients (5%). Interference of external fixation was the main cause of these problems. Follow up data was available for 86 patients, who were followed for a mean of 12 months (range 1 to 58 months). There was no significant difference in the complication rate between patients with a normal CTA (11%) and those with an abnormal CTA (8%), Chi Squared = 0.17, must be greater than 3.84 for significance. The CTA procedure itself did not cause any complications.
Conclusions: This is the largest reported series of CTA studies obtained for planning of reconstructive microsurgery. CTA is indicated mainly for assessment of recipient vessels. Our results show that CTA is highly accurate, safe, and has a strong influence on the reconstructive decision tree.