chapter  21
18 Pages

Angio-CT Imaging of Deep Inferior Epigastric Artery and Deep Superior Epigastric Artery Perforators

Breast reconstruction with adipocutaneous free aps from the abdominal wall combines the benets of abdominoplasty with those of a prosthesis-free breast reconstruction.1,2 The deep inferior epigastric perforator (DIEP) ap comprises the dissection of perforating branches of the deep inferior epigastric artery (DIEA) and deep inferior epigastric vein (DIEV) within the rectus abdominis muscle thus sparing both muscle and fascia.3,4 This aims to reduce abdominal wall morbidity but results in more meticulous surgery and microsurgical revascularisation.5-19

Because of the numerous variations in the vascular anatomy of the DIEA, preoperative imaging is useful.20-30 The ability to preoperatively dene the location and diameter of perforating vessels has many advantages: reduced learning curve, operative time, and abdominal morbidity as well as increased ap reliability.31-34

21.1 Overview ............................................................................................................................... 365 21.2 Vascular Anatomy of DIEP Flaps: Optimising Supply and Drainage .................................366 21.3 Multi-Slices CTA for DIEP Flaps......................................................................................... 367 21.4 Scanning Protocol ................................................................................................................. 369

21.4.1 Scanning Timing ...................................................................................................... 369 21.4.2 Study Range .............................................................................................................. 370 21.4.3 Technical Parameters ................................................................................................ 372

21.5 Preoperative Imaging: How to Do It .................................................................................... 372 21.5.1 Location Maps .......................................................................................................... 373 21.5.2 Vascular Pedicle ........................................................................................................ 374 21.5.3 Intramuscular Course ............................................................................................... 375 21.5.4 Supercial Inferior Epigastric Artery and Vein ....................................................... 377 21.5.5 Supercial Inferior Epigastric Vein to Perforator Communication .......................... 378 21.5.6 Abdominal Wall Competence and Contour ............................................................. 378

21.6 Summary .............................................................................................................................. 378 References ...................................................................................................................................... 379

Perforating branches of the DIEA and DIEV arise together through the rectus abdominis supercial fascial compounding a vascular pedicle.35-37 This vascular pedicle is used as vascular supply for DIEP ap. From this point, the main objective of any imaging technique performed for pre-surgical planning of DIEP ap is the identication of vascular pedicles with the widest calibre from those existing in each patient.