Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment
Abstract The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative eval...
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| Veröffentlicht in: | British journal of oral & maxillofacial surgery 2011-06, Vol.49 (4), p.275-280 |
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| container_title | British journal of oral & maxillofacial surgery |
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| creator | Hölzle, Frank Ristow, Oliver Rau, Andrea Mücke, Thomas Loeffelbein, Denys J Mitchell, David A Stimmer, Herbert Wolff, Klaus-Dietrich Kesting, Marco Rainer |
| description | Abstract The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA. |
| doi_str_mv | 10.1016/j.bjoms.2010.05.003 |
| format | Article |
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Part II: magnetic resonance angiography for standard preoperative assessment</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Hölzle, Frank ; Ristow, Oliver ; Rau, Andrea ; Mücke, Thomas ; Loeffelbein, Denys J ; Mitchell, David A ; Stimmer, Herbert ; Wolff, Klaus-Dietrich ; Kesting, Marco Rainer</creator><creatorcontrib>Hölzle, Frank ; Ristow, Oliver ; Rau, Andrea ; Mücke, Thomas ; Loeffelbein, Denys J ; Mitchell, David A ; Stimmer, Herbert ; Wolff, Klaus-Dietrich ; Kesting, Marco Rainer</creatorcontrib><description>Abstract The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA.</description><identifier>ISSN: 0266-4356</identifier><identifier>EISSN: 1532-1940</identifier><identifier>DOI: 10.1016/j.bjoms.2010.05.003</identifier><identifier>PMID: 20554360</identifier><identifier>CODEN: BJOSEY</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adult ; Aged ; Angiography, Digital Subtraction - methods ; Biological and medical sciences ; Bone Transplantation - methods ; Cadaver ; Cardiovascular system ; Collateral Circulation - physiology ; Constriction, Pathologic - diagnosis ; Contraindications ; Contrast Media ; Dentistry ; DSA ; Female ; Fibula - blood supply ; Fibula - surgery ; Free fibula flap ; Free Tissue Flaps - blood supply ; Graft Occlusion, Vascular - diagnosis ; Humans ; Image Enhancement - methods ; Investigative techniques, diagnostic techniques (general aspects) ; Leg - blood supply ; Magnetic Resonance Angiography - methods ; Male ; Mandibular Neoplasms - surgery ; Medical sciences ; Microsurgery ; Middle Aged ; MRA ; One vessel foot ; Otorhinolaryngology. Stomatology ; Peripheral Arterial Disease - diagnosis ; Preoperative Care ; Prospective Studies ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Radiographic Image Enhancement - methods ; Reconstructive Surgical Procedures - methods ; Surgery ; Tibial Arteries - pathology ; Tissue and Organ Harvesting - methods ; Young Adult</subject><ispartof>British journal of oral & maxillofacial surgery, 2011-06, Vol.49 (4), p.275-280</ispartof><rights>The British Association of Oral and Maxillofacial Surgeons</rights><rights>2010 The British Association of Oral and Maxillofacial Surgeons</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c443t-93ad04083e7e27cc69e155de30fe7313a72d3677b21b5fb68437e4d995d3c5803</citedby><cites>FETCH-LOGICAL-c443t-93ad04083e7e27cc69e155de30fe7313a72d3677b21b5fb68437e4d995d3c5803</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0266435610001452$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24273772$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20554360$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hölzle, Frank</creatorcontrib><creatorcontrib>Ristow, Oliver</creatorcontrib><creatorcontrib>Rau, Andrea</creatorcontrib><creatorcontrib>Mücke, Thomas</creatorcontrib><creatorcontrib>Loeffelbein, Denys J</creatorcontrib><creatorcontrib>Mitchell, David A</creatorcontrib><creatorcontrib>Stimmer, Herbert</creatorcontrib><creatorcontrib>Wolff, Klaus-Dietrich</creatorcontrib><creatorcontrib>Kesting, Marco Rainer</creatorcontrib><title>Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment</title><title>British journal of oral & maxillofacial surgery</title><addtitle>Br J Oral Maxillofac Surg</addtitle><description>Abstract The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA.</description><subject>Adult</subject><subject>Aged</subject><subject>Angiography, Digital Subtraction - methods</subject><subject>Biological and medical sciences</subject><subject>Bone Transplantation - methods</subject><subject>Cadaver</subject><subject>Cardiovascular system</subject><subject>Collateral Circulation - physiology</subject><subject>Constriction, Pathologic - diagnosis</subject><subject>Contraindications</subject><subject>Contrast Media</subject><subject>Dentistry</subject><subject>DSA</subject><subject>Female</subject><subject>Fibula - blood supply</subject><subject>Fibula - surgery</subject><subject>Free fibula flap</subject><subject>Free Tissue Flaps - blood supply</subject><subject>Graft Occlusion, Vascular - diagnosis</subject><subject>Humans</subject><subject>Image Enhancement - methods</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Leg - blood supply</subject><subject>Magnetic Resonance Angiography - methods</subject><subject>Male</subject><subject>Mandibular Neoplasms - surgery</subject><subject>Medical sciences</subject><subject>Microsurgery</subject><subject>Middle Aged</subject><subject>MRA</subject><subject>One vessel foot</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Peripheral Arterial Disease - diagnosis</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Radiographic Image Enhancement - methods</subject><subject>Reconstructive Surgical Procedures - methods</subject><subject>Surgery</subject><subject>Tibial Arteries - pathology</subject><subject>Tissue and Organ Harvesting - methods</subject><subject>Young Adult</subject><issn>0266-4356</issn><issn>1532-1940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkt-K1DAUh4so7rj6BILkRrxqzZ-mmQoKsqw6sKCgXoc0Pe2mtsmY047My_isps6sgjdehRO-czj8vpNlTxktGGXVy6FohjBhwWn6obKgVNzLNkwKnrO6pPezDeVVlZdCVhfZI8SBUio5kw-zC06lLEVFN9nP64MZFzO74EnoyHwL5ACIMOJdOYYfEMkIPWmgCxHI5GwMuMTeWTOSzjXLaCKZo_HYQSzIJxNnstu9IpPpPczOkggYvPEWiPG9C300-9sjScMIzsa3JrZkHyHsIaZFDolKCyBO4OfH2YPOjAhPzu9l9vXd9ZerD_nNx_e7q7c3uS1LMee1MC0t6VaAAq6srWpgUrYgaAdKMGEUb0WlVMNZI7um2pZCQdnWtWyFlVsqLrMXp7n7GL4vgLOeHFoYR-MhLKi3Va1qLiuRSHEi1xAwQqf30U0mHjWjevWiB_3bi169aCp18pK6np3nL80E7Z-eOxEJeH4GDKZYu5SmdfiXK7kSSvHEvT5xyRAcHESN1kGKtnUR7Kzb4P6zyJt_-u3o_GryGxwBh7BEn4LWTCPXVH9eT2i9IJaOh5WSi18ao8RS</recordid><startdate>20110601</startdate><enddate>20110601</enddate><creator>Hölzle, Frank</creator><creator>Ristow, Oliver</creator><creator>Rau, Andrea</creator><creator>Mücke, Thomas</creator><creator>Loeffelbein, Denys J</creator><creator>Mitchell, David A</creator><creator>Stimmer, Herbert</creator><creator>Wolff, Klaus-Dietrich</creator><creator>Kesting, Marco Rainer</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20110601</creationdate><title>Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment</title><author>Hölzle, Frank ; Ristow, Oliver ; Rau, Andrea ; Mücke, Thomas ; Loeffelbein, Denys J ; Mitchell, David A ; Stimmer, Herbert ; Wolff, Klaus-Dietrich ; Kesting, Marco Rainer</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c443t-93ad04083e7e27cc69e155de30fe7313a72d3677b21b5fb68437e4d995d3c5803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Angiography, Digital Subtraction - methods</topic><topic>Biological and medical sciences</topic><topic>Bone Transplantation - methods</topic><topic>Cadaver</topic><topic>Cardiovascular system</topic><topic>Collateral Circulation - physiology</topic><topic>Constriction, Pathologic - diagnosis</topic><topic>Contraindications</topic><topic>Contrast Media</topic><topic>Dentistry</topic><topic>DSA</topic><topic>Female</topic><topic>Fibula - blood supply</topic><topic>Fibula - surgery</topic><topic>Free fibula flap</topic><topic>Free Tissue Flaps - blood supply</topic><topic>Graft Occlusion, Vascular - diagnosis</topic><topic>Humans</topic><topic>Image Enhancement - methods</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Leg - blood supply</topic><topic>Magnetic Resonance Angiography - methods</topic><topic>Male</topic><topic>Mandibular Neoplasms - surgery</topic><topic>Medical sciences</topic><topic>Microsurgery</topic><topic>Middle Aged</topic><topic>MRA</topic><topic>One vessel foot</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Peripheral Arterial Disease - diagnosis</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Radiographic Image Enhancement - methods</topic><topic>Reconstructive Surgical Procedures - methods</topic><topic>Surgery</topic><topic>Tibial Arteries - pathology</topic><topic>Tissue and Organ Harvesting - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hölzle, Frank</creatorcontrib><creatorcontrib>Ristow, Oliver</creatorcontrib><creatorcontrib>Rau, Andrea</creatorcontrib><creatorcontrib>Mücke, Thomas</creatorcontrib><creatorcontrib>Loeffelbein, Denys J</creatorcontrib><creatorcontrib>Mitchell, David A</creatorcontrib><creatorcontrib>Stimmer, Herbert</creatorcontrib><creatorcontrib>Wolff, Klaus-Dietrich</creatorcontrib><creatorcontrib>Kesting, Marco Rainer</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of oral & maxillofacial surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hölzle, Frank</au><au>Ristow, Oliver</au><au>Rau, Andrea</au><au>Mücke, Thomas</au><au>Loeffelbein, Denys J</au><au>Mitchell, David A</au><au>Stimmer, Herbert</au><au>Wolff, Klaus-Dietrich</au><au>Kesting, Marco Rainer</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment</atitle><jtitle>British journal of oral & maxillofacial surgery</jtitle><addtitle>Br J Oral Maxillofac Surg</addtitle><date>2011-06-01</date><risdate>2011</risdate><volume>49</volume><issue>4</issue><spage>275</spage><epage>280</epage><pages>275-280</pages><issn>0266-4356</issn><eissn>1532-1940</eissn><coden>BJOSEY</coden><abstract>Abstract The peroneal artery is the dominant supply of the osteomyocutaneous fibular flap. It has been shown that there can be anatomical variants that could jeopardise the blood supply to the lower limb during harvest of the flap. To avoid postoperative ischaemia of the lower leg, preoperative evaluation of adequate collateral perfusion is essential. We investigated whether magnetic resonance angiography (MRA) accurately shows anatomical variants and pathological stenoses of the vessels of the lower leg and whether it can replace conventional invasive techniques. Conventional digital subtraction angiography (DSA) was used in a prospective study of 15 patients, and contrast-enhanced MRA postoperatively. Arteries were evaluated by three radiologists for: size of vessel at the trifurcation; hypoplastic or missing vessels; appreciable stenosis or vascular occlusion, or both; atherosclerotic malformations; and overall vascular topography. High resolution MRA enabled a reliable judgement to be made of the vessels of the lower leg. MRA definitively detected hypoplastic vessels, stenoses, occlusion, or atherosclerotic changes of the vessels, and enabled both accurate assessment of the quality of vessels and the preferred site for the harvest of the flap. As it is a low risk procedure, it can be done in the outpatient department with no risk of radiation. It can easily replace conventional DSA.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>20554360</pmid><doi>10.1016/j.bjoms.2010.05.003</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Angiography, Digital Subtraction - methods Biological and medical sciences Bone Transplantation - methods Cadaver Cardiovascular system Collateral Circulation - physiology Constriction, Pathologic - diagnosis Contraindications Contrast Media Dentistry DSA Female Fibula - blood supply Fibula - surgery Free fibula flap Free Tissue Flaps - blood supply Graft Occlusion, Vascular - diagnosis Humans Image Enhancement - methods Investigative techniques, diagnostic techniques (general aspects) Leg - blood supply Magnetic Resonance Angiography - methods Male Mandibular Neoplasms - surgery Medical sciences Microsurgery Middle Aged MRA One vessel foot Otorhinolaryngology. Stomatology Peripheral Arterial Disease - diagnosis Preoperative Care Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Radiographic Image Enhancement - methods Reconstructive Surgical Procedures - methods Surgery Tibial Arteries - pathology Tissue and Organ Harvesting - methods Young Adult |
| title | Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part II: magnetic resonance angiography for standard preoperative assessment |
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