Equilibrium-Phase High Spatial Resolution Contrast-Enhanced MR Angiography at 1.5T in Preoperative Imaging for Perforator Flap Breast Reconstruction

Versluis, Bas; Tuinder, Stefania; Boetes, C.; Hulst, René van der; Lataster, Arno; Mulken, Tom Van; Wildberger, Joachim E.; Haan, Michiel de; Leiner, Tim

doi:10.1371/journal.pone.0071286

Cited by 9 publications

(15 citation statements)

References 19 publications

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“…16 Of the tests used for identifying perforators as part of the preoperative assessment for a perforator flap surgery, the results using CTA and MRA were well described. [4][5][6] However, the disadvantages of CTA and MRA are high cost, radiation exposure, possible allergic reaction to the contrast agents, and difficulty in detecting small vessels. After the first clinical results following the use of color Doppler US were reported in 1994, technological advancements have enabled us to detect reduced blood flow in superficial vessels with a diameter as small as 0.2 mm using higher-frequency transducers.…”

Section: Discussionmentioning

confidence: 99%

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Ishiko

Yano

Onode

et al. 2020

J Reconstr Microsurg

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Background The ulnar artery perforator (UAP) flap, which is hairless, thin, and pliable, has been used for the reconstruction of soft tissues from the finger to the elbow. Preoperative planning is essential for a perforator flap surgery, and there are some tests to identify perforators. Color Doppler ultrasonography (US) with a high-frequency transducer helps in detecting decreased flow in smaller vessels, such as perforators. The purpose of this study was to determine the anatomical locations and origins of perforators arising from the ulnar artery using color Doppler US in healthy volunteers. Methods Forty forearms of 20 healthy volunteers were included in the study. Perforators arising from the ulnar artery, within 100 mm proximal to the pisiform, were investigated using color Doppler US with a high-frequency transducer. Results A total of 205 perforators were identified. On comparing the locations in each 20 mm section from the pisiform, the largest number of perforators was 58 (28%), within 20 mm proximal to the pisiform. The axial view demonstrated 44 (21%), 64 (31%), 32 (16%), and 65 (32%) perforators in the radial, ulnar, superficial, and deep aspects of the ulnar artery, respectively. Fifty-two and 28 essential perforators were supplied by the UAPs arising from the superficial and ulnar aspect within 20 mm proximal to the pisiform and between 21 and 40 mm proximal to the pisiform, respectively, while elevating the UAP flap. Conclusion This is the first study to assess the UAP using color Doppler US. Identification of UAP using color Doppler US can be used as a preoperative assessment for reliable elevation of a UAP flap.

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Section: Discussionmentioning

confidence: 99%

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Ishiko

Yano

Onode

et al. 2020

J Reconstr Microsurg

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“…Early studies have shown accurate localization of perforators with MRA for DIEP flaps [1,15,[32][33][34][35][36][37]. Application of novel MR techniques, such as the use of unenhanced MRA, has shown promise as the vessels can be visualized without intravenous administration of contrast [35].…”

Section: Preoperative Imagingmentioning

confidence: 99%

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Imaging

Oliva

Day

et al. 2017

Journal of the American College of Radiology

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Breast cancer is the most common malignancy in women in the United States. Breast reconstruction surgery is a commonly used therapy for patients with breast cancer. The technique for the deep inferior epigastric perforator flap uses a preserved rectus muscle, which decreases donor site morbidity. Accurate identification and measurement of the perforator branches of the deep inferior epigastric artery is pivotal during pre-operative planning so that the surgeon can prioritize the best vessel to use and ultimately improve clinical outcome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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“…Peripheral arterial disease (PAD), characterized by arteriosclerotic stenosis or occlusion of pelvic and/or lower extremity arteries, may manifest clinically as intermittent claudication or critical limb ischemia (1). The primary treatment for patients with intermittent claudication is supervised exercise therapy, which may stimulate collateral blood artery formation to increase muscle perfusion (1)(2)(3).…”

Section: Introduction Introduction Introduction Introductionmentioning

confidence: 99%

“…Arteriosclerotic peripheral arterial disease (PAD) is a major health care problem among the elderly in the Western society. The estimated prevalence of PAD in the general population is in the range of 3% to 10%, which increases up to 15-20% in persons over 70 years (1)(2)(3)(4). In the Netherlands, the estimated prevalence among persons over 55 years is 19.1%, ranging from 8.1% at the age of 55-59 years towards 55.8% in persons over 85 years (5).…”

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confidence: 99%

“…lesions of the large conduit arteries of the lower extremities, disorders might also be present at the microvascular level, in which small arteries, arterioles and capillaries are affected. Microvascular disease comprises endothelial and vascular smooth muscle cell dysfunction and inflammation, which results in a disturbed production of vaso-active substances, leading to increased vascular tone and damage (1,(7)(8)(9)(10). Microvascular disease is most pronounced in the majority of the subgroup of PAD patients with diabetes mellitus, whereas macrovascular disease is the major cause of symptoms in non-diabetic PAD patients (1,(7)(8)(9)(10).…”

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confidence: 99%

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Quantitative morphologic and functional MRI of peripheral arterial disease

Versluis¹

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Equilibrium-Phase High Spatial Resolution Contrast-Enhanced MR Angiography at 1.5T in Preoperative Imaging for Perforator Flap Breast Reconstruction

Cited by 9 publications

References 19 publications

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Quantitative morphologic and functional MRI of peripheral arterial disease

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