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[Reliability and risks of angiography in microsurgery]
1Klinik für Kiefer- und Plastische Gesichtschirurgie Berlin.
Insights
Preoperative angiography aids microvascular surgery planning, but can complicate procedures due to contrast medium. Routine use is advised only for altered surgical sites, with a 2-day washout interval before surgery.
Area of Science:
- Vascular Surgery
- Medical Imaging
Background:
- Angiography is a standard imaging technique for deep iliac circumflex, inferior epigastric, and external pudendal arteries.
- Smaller superficial vessels (superficial iliac circumflex, superficial epigastric, muscular branches) are visualized in only 70-90% of cases.
- Vascular calcification in the femoral artery can impede cannulation of smaller arterial origins.
Purpose of the Study:
- To evaluate the utility and limitations of preoperative angiography in microvascular surgery.
- To identify potential complications associated with contrast medium use in microvascular procedures.
Main Methods:
- Review of angiography's effectiveness in visualizing various arterial vessels.
- Analysis of complications arising from contrast medium presence before microvascular anastomoses.
Main Results:
- Angiography reliably visualizes larger deep arteries but struggles with smaller superficial vessels.
- Contrast medium remnants can compromise vessel patency and complicate anastomotic procedures.
- High viscosity of contrast medium may lead to stasis in microvasculature.
Conclusions:
- Preoperative angiography is valuable for treatment planning in microvascular surgery.
- Routine angiography is recommended only for cases involving previously altered surgical sites.
- A minimum 2-day interval between angiography and surgery is crucial for complete contrast medium washout.
Abstract:
Angiography is a reliable method for imaging the deep iliac circumflex, the inferior epigastric and the external pudendal artery. However, 10-30% of all arteriograms fail to visualize the superficial iliac circumflex, the superficial epigastric artery, and the muscular branch, whose lumina are generally 1 mm smaller at their origins. The reason for this may be associated with the cannulization of the vascular lumen for injection of the contrast medium (see below): while the cannula could be easily inserted in the larger vessels mentioned first, cannulation was occasionally complicated by calcareous deposits in the femoral artery which narrowed the lumen of the latter arteries at their origins. In smaller vessels angiography provides no conclusive information on degenerative alterations. Angiography performed immediately before microvascular anastomosing highly jeopardized the vessel's patency. Remnants of the highly viscous and sticky contrast medium that remain attached to the vascular wall complicate the technical procedure of anastomosing. In a free flap with its numerous anastomoses cut off, the medium's high viscosity may result in stasis first in the capillaries and ultimately in the trunk. According to the present results preoperative angiography is a useful method for treatment planning in microvascular surgery. However we should call for the routine application of this technique only in those cases, where the host or donor site has been changed in a previous surgical intervention. To ensure complete washout of the contrast medium, there should be an interval of at least 2 days between angiography and surgery.