Computed tomography angiography in microsurgery: indications, clinical utility, and pitfalls
Gordon K Lee1, Paige M Fox, Jonathan Riboh
1Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif.
Eplasty
|September 12, 2013
Summary
Computed tomographic angiography (CTA) is a safe and accurate tool for planning microvascular reconstruction. CTA can alter surgical plans and improve outcomes by identifying vascular abnormalities before surgery.
Area of Science:
- Vascular Surgery
- Radiology
- Microsurgery
Background:
- Computed tomographic angiography (CTA) provides detailed 3D vascular and soft-tissue imaging.
- Preoperative planning is crucial for successful microvascular reconstructive surgery.
Purpose of the Study:
- To evaluate the reliability, usefulness, and potential pitfalls of CTA in preoperative planning for microvascular reconstructive surgery.
Main Methods:
- Retrospective review of 94 patients undergoing preoperative CTA for microvascular reconstruction between 2001-2005.
- Assessed CTA's influence on operative plans and correlated CTA findings with intraoperative results.
Main Results:
- CTA identified vascular abnormalities in 51% of patients.
- 97% correlation between CTA findings and intraoperative results.
- 45% of cases had altered surgical plans due to CTA findings, impacting vessel choice or reconstruction type.
- Technical difficulties occurred in 5% of cases, primarily due to external fixation devices.
Conclusions:
- CTA is safe and highly accurate for preoperative planning in reconstructive microsurgery.
- CTA can significantly alter surgical plans, potentially improving outcomes and reducing vascular complications.
- Consider CTA for microsurgical cases with questionable vascular anatomy.
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