CTA Abdomen and Pelvis With IV Contrast CTA is currently beneficial in evaluating the perforator anatomy for preoperative planning before DIEP flap breast reconstruction. Perforator size, perforator location relative to abdominal landmarks, branching pattern of DIEA, presence of superficial inferior epigastric vessels, subcutaneous course, and intramuscular course all affect operative techniques, operative time, and outcomes. CTA is a fast, efficient, and highly reproducible modality, capable of yielding excellent opacification of the small caliber perforator arteries with optimal contrast bolus timing. CTA evaluation performed with the use of specific postprocessing and display techniques may yield more accurate assessment of the optimal vessel for selection for breast reconstruction when compared to color Doppler ultrasound (CDU) [2,8,16]. Some studies have demonstrated superiority of CTA over CDU utilization [17,18], suggesting a routine use of preoperative CTA. A virtual 3-D plan based on CTA can be preoperatively projected onto the abdomen intraoperatively, which can aid in identifying perforator locations and thus decreasing operative time [19]. CTA is also helpful in predicting which DIEA perforators are the most clinically useful in patients with scarred abdomens [20]. Therefore, preoperative imaging is essential for DIEP flap surgery [17,21-28]. Preoperative CTA evaluation can also reliably estimate the volume of abdominal tissue for DIEP flap breast reconstruction [19,29]. Imaging of Deep Inferior Epigastric Arteries Preoperative mapping allows calculation of a flap viability index, which predicts the amount of tissue which will survive based on perforator diameter as well as flap weights [30]. CTA evaluation also allows for the assessment of factors, which may lead to venous congestion of the flap and, therefore, flap failure [31].
Imaging of Deep Inferior Epigastric Arteries for Surgical Planning Breast Reconstruction Surgery . CTA Abdomen and Pelvis With IV Contrast CTA is currently beneficial in evaluating the perforator anatomy for preoperative planning before DIEP flap breast reconstruction. Perforator size, perforator location relative to abdominal landmarks, branching pattern of DIEA, presence of superficial inferior epigastric vessels, subcutaneous course, and intramuscular course all affect operative techniques, operative time, and outcomes. CTA is a fast, efficient, and highly reproducible modality, capable of yielding excellent opacification of the small caliber perforator arteries with optimal contrast bolus timing. CTA evaluation performed with the use of specific postprocessing and display techniques may yield more accurate assessment of the optimal vessel for selection for breast reconstruction when compared to color Doppler ultrasound (CDU) [2,8,16]. Some studies have demonstrated superiority of CTA over CDU utilization [17,18], suggesting a routine use of preoperative CTA. A virtual 3-D plan based on CTA can be preoperatively projected onto the abdomen intraoperatively, which can aid in identifying perforator locations and thus decreasing operative time [19]. CTA is also helpful in predicting which DIEA perforators are the most clinically useful in patients with scarred abdomens [20]. Therefore, preoperative imaging is essential for DIEP flap surgery [17,21-28]. Preoperative CTA evaluation can also reliably estimate the volume of abdominal tissue for DIEP flap breast reconstruction [19,29]. Imaging of Deep Inferior Epigastric Arteries Preoperative mapping allows calculation of a flap viability index, which predicts the amount of tissue which will survive based on perforator diameter as well as flap weights [30]. CTA evaluation also allows for the assessment of factors, which may lead to venous congestion of the flap and, therefore, flap failure [31].