A superficial inferior epigastric vein larger than the deep inferior epigastric vein as well as axial nonarborizing superficial venous system are highly predictive of subsequent venous congestion. Knowledge of these findings can aid in preoperative discussion with patients, which may alter management [32]. Preoperative use of CTA allows estimation of contralateral abdominal perfusion and therefore allows for efficient breast reconstruction and decreased complications [33]. Use of preoperative CTA has been shown to result in the increased use of single perforators, increased use of medial- row perforators, significantly reduced operative time, decreased intraoperative blood loss, decreased inpatient hospital stay, and decreased complications such as hernias [9,11,12,14,34]. CTA evaluation allows for faster selection of laterality of dissection, as well as reduced flap loss rates [15]. MRA Abdomen and Pelvis Without and With IV Contrast Donor site preoperative imaging for mapping the perforator artery anatomy results in improvement in perforator selection, reduces operative time, and reduces donor site morbidity. Although CTA is considered most helpful, emerging literature supports MR angiography (MRA) as an alternative imaging tool with accurate assessment of DIEA perforator anatomy [35-44]. A recent meta-analysis demonstrates that CT and MRI appear to have similar accuracy in preoperative DIEP mapping [44]. MRA evaluation is limited by increased scanning times relative to CTA evaluation. Continued research is needed to evaluate the accuracy of the new emerging MRA techniques and their role in preoperative perforator branch imaging. MRA Abdomen and Pelvis Without IV Contrast The literature review yields one study that used noncontrast MRA for preoperative planning in 56 women who underwent DIEP flap with preoperative planning using MRA without IV contrast.
Imaging of Deep Inferior Epigastric Arteries for Surgical Planning Breast Reconstruction Surgery . A superficial inferior epigastric vein larger than the deep inferior epigastric vein as well as axial nonarborizing superficial venous system are highly predictive of subsequent venous congestion. Knowledge of these findings can aid in preoperative discussion with patients, which may alter management [32]. Preoperative use of CTA allows estimation of contralateral abdominal perfusion and therefore allows for efficient breast reconstruction and decreased complications [33]. Use of preoperative CTA has been shown to result in the increased use of single perforators, increased use of medial- row perforators, significantly reduced operative time, decreased intraoperative blood loss, decreased inpatient hospital stay, and decreased complications such as hernias [9,11,12,14,34]. CTA evaluation allows for faster selection of laterality of dissection, as well as reduced flap loss rates [15]. MRA Abdomen and Pelvis Without and With IV Contrast Donor site preoperative imaging for mapping the perforator artery anatomy results in improvement in perforator selection, reduces operative time, and reduces donor site morbidity. Although CTA is considered most helpful, emerging literature supports MR angiography (MRA) as an alternative imaging tool with accurate assessment of DIEA perforator anatomy [35-44]. A recent meta-analysis demonstrates that CT and MRI appear to have similar accuracy in preoperative DIEP mapping [44]. MRA evaluation is limited by increased scanning times relative to CTA evaluation. Continued research is needed to evaluate the accuracy of the new emerging MRA techniques and their role in preoperative perforator branch imaging. MRA Abdomen and Pelvis Without IV Contrast The literature review yields one study that used noncontrast MRA for preoperative planning in 56 women who underwent DIEP flap with preoperative planning using MRA without IV contrast.