Schulte R, Loberg C, Ghassemi A. Evaluating the length, diameter, and stenosis of deep circumflex iliac artery and neighboring arteries based on digital subtraction angiography.
Microsurgery 2023;
43:373-381. [PMID:
36762598 DOI:
10.1002/micr.31022]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 12/31/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND
The vascularized iliac bone crest flap offers excellent usable bone in terms of volume and quality. Its nourishing vessel, the deep circumflex iliac artery (DCIA), although relatively short, is reliable vessel. Digital subtraction angiography presents still the gold standard for diagnostic purpose. However, computed tomography (CT) and magnetic resonance imaging (MRI) angiography is used for preoperative planning with low morbidity. The purpose of this study is to evaluate the gainable information using digital subtraction angiography (DSA) as compared to other imaging modalities.
MATERIALS AND METHODS
We evaluated information gainable from standard DSA of 130 consecutive patients (average age was 69.5 years [range 18-90 years]) concerning topography, dimension, and condition of the vessel wall. We looked for differences considering gender and side.
RESULTS
DCIA could not be followed in the periphery constantly in all cases due to the small, illustrated field. Arteriosclerotic changes showed to be very low in DCIA as compared to the neighboring vessels. Diabetes mellitus and smoking had a significant impact on vessel condition. DCIA branched off into its main two branches early after 40 mm (11%), after 40-60 mm (30%), or late after 60 mm (59%). DCIA showed to be least affected by different risk factors that reported to affect the vessel condition.
CONCLUSIONS
We present additional detailed topographic anatomy of DCIA and its variation that can be used intraoperative guide to harvest the flap and teaching purpose. Standard DSA delivers valuable preoperative data regarding stenosis in addition to the topographic anatomy of the flap pedicle. However, imaging of the distal parts of the DCIA, nourishing the skin paddle is limited by the detector field used. For a full imaging of both DCIAs from the origin to the perforators, the intraarterial injection of contrast medium, as applied in DSA, could be combined with different imaging modalities like CT-angiography.
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