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Vascular Mapping of the Leg with Multi–Detector Row CT Angiography prior to Free-Flap Transplantation¹

¹ From the Department of Radiology (L.C.C., A.N., G.D.R.) and Division of Plastic and Reconstructive Surgery (M.B.K., J.C.), Stanford University Medical Center, 300 Pasteur Dr, Rm H1307, Stanford, CA 94305. From the 2001 RSNA Annual Meeting. Received April 13, 2004; revision requested June 24; revision received November 4; accepted December 21. Address correspondence to L.C.C. (e-mail: lchow{at}visionradiology.com).

PURPOSE: To retrospectively evaluate multi–detector row computed tomographic (CT) angiography in determining donor- and recipient-site arterial suitability for successful vascularized free-flap transplantation.

MATERIALS AND METHODS: The institutional review board granted approval; informed consent was waived, and the study was HIPAA compliant. Lower extremities of 20 (12 male, eight female; mean age, 51 years; range, 10–84 years) patients undergoing vascularized free-flap procedures were examined at multi–detector row CT angiography. In five patients, legs were assessed as potential fibular free-flap donors for mandibular, maxillary, or radial reconstruction. In 15 patients, legs were assessed as recipient sites for free flaps. Vascular maps obtained with volume rendering, maximum intensity projections, and curved planar reformations were generated, and assessment was made in the depiction of calf vessels and presence of stenosis, occlusion, and anatomic anomaly. Findings of CT angiography, physical examination, and surgery were compared, where applicable, and successful CT-based prediction of the surgical intervention was assessed. Immediate and long-term (>70 days) viability of the graft was assessed in all patients.

RESULTS: CT angiography depicted the entirety of all four major calf arteries in 29 of 32 legs scanned. In three legs, external-fixation hardware obscured some segments. There were no discrepancies between CT findings and those identified at the time of surgery. Arterial abnormalities, including stenosis, occlusion, and variant anatomy, were seen in 12 lower extremities in 10 patients. Only two were suspected on the basis of physical examination findings. In five of 20 patients, CT findings resulted in changes to the surgical plan. There was a 100% immediate viability of all grafts, which remained well vascularized between 70 days and 37 months after the procedure.

CONCLUSION: Multi–detector row CT angiography provides a noninvasive means of preoperatively assessing lower extremity arteries for abnormalities, which could jeopardize graft viability or pedal arterial supply after free-flap procedures.

© RSNA, 2005

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