POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information References

ECR 2018 / C-3143

A road map to the deep inferior epigastric artery flap

Congress:

ECR 2018

Poster Number:

C-3143

Type:

Educational Exhibit

Keywords:

Prostheses, Multidisciplinary cancer care, Surgery, Normal variants, Computer Applications-3D, CT-Angiography, Arteries / Aorta, Anatomy, Abdomen

Authors:

M. Camargo Montanari, C. Sainz Azara, C. G. Linares Villavicencio, M. Del Palacio Salgado, F. cabrera canal, M. Gamo, M. A. Cruz Díaz; Alcalá de Henares. Madrid/ES

DOI:

10.1594/ecr2018/C-3143

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-3143

Fig. 10: Courtesy of Dr. Jesus Sanchez Martin.

Fig. 11: Courtesy of Dr. Jesus Sanchez Martin.

Fig. 13: Courtesy of Dr. Jesus Sanchez Martin.

Fig. 14: Courtesy of Dr. Jesus Sanchez Martin.

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Fig. 12: Courtesy of Dr. Jesus Sanchez Martin.

Fig. 15: Courtesy of Dr. Jesus Sanchez Martin.

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Learning objectives

To describe and illustrate our experience in the acquisition and interpretation of computed tomographic angiography (CTA) of the abdominal wall as a preoperative vascular study in breast reconstruction with DIEP (Deep Inferior Epigastric Perforator) flap, defining the technical parameters used to obtain optimal images.

Background

1) Introduction Mastectomy remains a mainstay for treatment of breast cancer. Is a surgical procedure with associated functional deficits and with psychosocial effects, which are probably the most important consequences for women undergoing this procedure. The breast reconstruction can improve the psychosocial well-being and quality of life of patients who have cancer. This procedure includes the volume restoration and the reconstruction of the areola-nipple complex. Various options for breast reconstruction exist. Most women choose either silicone or adjustable saline implants, although the choice may commit...

Findings and procedure details

The evaluation of the perforating arteries can be done with different imaging techniques that can greatly improve the efficiency of the selection process, being the most useful: • Doppler ultrasonography (US), is the most frequently used modality for vascular mapping, but the results are mixed because most perforating arteries have a diameter of less than 15 mm, the threshold for reliable visualization with US. • A computed tomographic angiography (CTA) evaluation performed with the use of specific postprocessing and display techniques may be more accurate...

Conclusion

Abdominal wall CTA is a non invasive technique and is a valuable tool in presurgical evaluation of breast reconstruction with DIEP flap due to its ability to define the anatomy of vessels, providing information that optimizes the preoperative planning and improve the prognosis. Alert of the presence of anatomic variants that can increase the surgical time leading to an unfavourable result. The knowledge of the relevant anatomy, the surgical technique and the protocols for the acquisition of CTA images can facilitate the interpretation of the...

Personal information

References

1. Karunanithy N., Rose V., Lim A., et al. CT Angiography of Inferior Epigastric and Gluteal Perforating Arteries before Free Flap Breast Recontruccion. RadioGraphics 2011; 31: 1307-19. 2. Cordeiro PG. Breast Reconstruction after Surgery for Breast Cancer. N Engl J Med 2008;359:1590-601. 3. Phillips TJ, Stella DL, Rozen WM, et al. Abdominal wall CT angiography: a detailed account of a newly established preoperative imaging technique. Radiology 2008;249: 32-44. 4. Nahabedian MY. Secondary Operations of the Anterior Abdominal Wall following Microvascular Breast Reconstruction with the TRAM...