Spiral CT angiography: an alternative vascular evaluation technique for head and neck microvascular reconstruction

Facial trauma and head and neck oncologic patients are often destined for extensive reconstructive procedures with microvascular free flaps due to ablative injuries or postoperative defects. The integrity and competence of the vasculature in the head and neck recipient site must be imaged and evaluated preoperatively as an essential prerequisite for the success of the reconstructive transfer. In a prospective study of five patients, we compared conventional angiography, the traditional technique, with a new vascular imaging modality--spiral computed tomographic (CT) angiography. One patient suffered from an extensive, ablative facial trauma, and the other four had undergone mandibulectomy as part of their oncologic therapy. In contrast to conventional angiography, spiral CT angiography is a noninvasive imaging technique, which we found to be characterized by much shorter patient examination time, avoidance of selective cannulation with its attendant risks, improved perception of anatomy, and the ability to rotate the reconstructed images in any plane to obtain the best view of any vessel in question. Disadvantages of spiral CT angiography in imaging vessels include the need for relatively large amounts of contrast medium, great dependence on the skill and experience of the operator, and the need for optimizing the timing of the contrast bolus and the scan.