Background: In the last few years, the use of Deep Inferior Epigastric Perforator (DIEP) flap for breast reconstruction has increased. In the process, the surgeon has to select the perforating artery that is most suitable for the vascular pedicle. A computed tomographic angiographic evaluation will help to identifying this vessel. The radiologist has an important role in this identification that will optimize surgical planning, decrease surgical time and improve the outcome of breast reconstruction surgery.
Learning Objectives: The vascular anatomy of the superficial inferior epigastric artery had multiple variables that must be kept in mind during the pre-operative evaluation for the realization of the flap. The angiographic images will help to identify those variables and determines if the patient is candidate for the surgery.
The radiologist had to report the anatomic variables, size, location (relative to the umbilicus), course and length of the deep inferior epigastric perforating arteries.
Abstract Content/Results: We present cases of our institution of patients with breast cancer thar were candidates for reconstructions surgeries with DIEP flap and patients that after the CT angiographic were ruled out for absence of suitable vessels.
We show the protocol of the computed tomographic angiographic we use and the specifics postprocessing techniques that provide more accurate findings for identification of the vessels.
Finally, we propose an organized structured report that will help the radiologist to describe and mention everything necessary to guide the surgeon to select the most suitable vessel.
Conclusion: The radiologist plays a very important role in the setting of evaluation of the Deep Inferior Epigastric Perforator flap in breast cancer patient from the realization of the CT angiographic with adequate postprocessing techniques, reporting all the variables necessaries for the surgeon to select the most suitable vessel that finally will help to reduce procedure time and lead to better outcomes.
