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Related Experiment Video

Updated: Apr 16, 2026

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Three-dimensional venous visualization with phase-lag computed tomography angiography for reconstructive

Shunsuke Sakakibara1, Hiroyuki Onishi2, Kazunobu Hashikawa1

  • 1Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Journal of Reconstructive Microsurgery
|March 19, 2015
PubMed
Summary

Phase-lag computed tomography angiography (pl-CTA) enhances free flap reconstructions by visualizing venous anatomy. This technique aids in planning, especially for complex head and neck cases, reducing vascular complications.

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Area of Science:

  • Medical Imaging
  • Vascular Surgery
  • Reconstructive Surgery

Background:

  • Free flap reconstruction complications often stem from vascular compromise.
  • While arterial anatomy imaging is established, venous anatomy visualization is crucial for preventing thrombotic complications.
  • Accurate vascular assessment is key to minimizing free flap failure.

Purpose of the Study:

  • To evaluate the utility of phase-lag computed tomography angiography (pl-CTA) for detailed venous anatomy imaging in free flap reconstruction planning.
  • To assess the effectiveness of pl-CTA in identifying and avoiding compromised venous structures.
  • To determine if pl-CTA can improve outcomes in complex reconstructive scenarios.

Main Methods:

  • Utilized a 64-channel (virtually 128-channel) multidetector CT scanner for pl-CTA.
  • Acquired arterial images using conventional computed tomography angiography (CTA).
  • Reconstructed 3D venous images using a subtraction technique combining venous and arterial phase data on a workstation.

Main Results:

  • Successfully applied pl-CTA to 48 patients undergoing free flap reconstructions (lower leg, head/neck, upper extremity) without complications.
  • Demonstrated 3D visualization of peripheral veins as small as 1 mm in diameter.
  • Identified specific benefits in head and neck reconstructions post-malignancy and in avoiding varicose veins in lower leg cases.

Conclusions:

  • Phase-lag computed tomography angiography provides valuable 3D venous anatomy information for free flap transfer planning.
  • The technique is particularly beneficial for secondary reconstructions in the head and neck region.
  • pl-CTA aids in avoiding suboptimal vessels, thereby enhancing surgical planning and potentially reducing complications.