scholarly journals Doppler Ultrasound and Computed Tomography Angiography Application in Planning of Lower Extremities Perforator Flaps for the Reconstruction of Acquired Maxillofacial Defects (Case Report)

2021 ◽  
pp. 74-81
Author(s):  
A. A. Trefilov ◽  
E. V. Kryukov ◽  
V. N. Troyan ◽  
S. V. Tereshchuk ◽  
V. A. Suharev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
Clinical Case ◽  
Preoperative Planning ◽  
Surgical Intervention ◽  
Circulatory System ◽  
Perforator Flap ◽  
Perforator Flaps ◽  
Donor Area

The study describes a clinical case of preoperative planning of an anterolateral femur perforator flap and a peroneal autograft to eliminate a maxillofacial defect. During preparation for the surgery, an anatomical feature of the structure of both extremities circulatory system was found, which did not allow full use of the donor area tissues for subsequent surgical intervention. This feature was identified by Doppler ultrasound, but the final picture became clear only due to the study by computed tomography angiography.

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

scholarly journals The role of doppler ultrasound and multislice spiral computed tomography angiography in the common form of stomach cancer diagnosis

2016 ◽  
Vol 97 (1) ◽  
pp. 59-65
Author(s):  
I Z Pulatova ◽  
M A Isamukhamedova
Keyword(s):  
Gastric Cancer ◽  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
Abdominal Cavity ◽  
Spiral Computed Tomography ◽  
Diagnostic Methods ◽  
Spiral Computed ◽  
Multislice Spiral Computed Tomography ◽  
Great Vessels

Aim. To evaluate the results of Doppler ultrasound and multislice computed tomography angiography in patients with gastric cancer and the sensitivity of these diagnostic methods for the detection of the abdomen great vessels lesions.Methods. The study included 32 patients aged 37 to 82 years who had histologically confirmed gastric adenocarcinoma diagnosis. The control group consisted of 30 apparently healthy people of the same age. Transabdominal ultrasonography of the abdominal cavity organs and stomach in gray-scale mode (B-mode before and after the stomach filling with degassed liquid), Doppler ultrasound of the abdomen and the stomach wall vessels, multislice spiral computed tomography angiography were performed in all patients at the preoperative stage. The analysis of the study results and their comparison with intraoperative data were conducted.Results. In patients with gastric cancer a statistically significant increase in peak systolic velocity in the celiac trunk, superior mesenteric artery, left gastric artery and resistive index decrease in these blood vessels (p <0.05) with the presence of atypical vascularization in the affected stomach walls were registered. The data obtained during the multislice spiral computed tomography angiography were analyzed. The sensitivity of Doppler ultrasound in the preoperative detection of abdominal cavity great vessels affection in patients with gastric cancer was 77.8%, multislice spiral computed tomography angiography - 88.9%, the combination of these two methods - 96.3%.Conclusion. The analysis of used diagnostic methods of examination of patients with stomach cancer showed that Doppler ultrasound should be included in the patients examination standard to assess the abdominal cavity great vessels condition, what is important in deciding on the possibility of operative intervention; the sensitivity of the combination of dopplerography and multislice spiral computed tomography angiography in the diagnosis of great vessels affection is 96.3%.

scholarly journals Angiographic Pitfall: Duplicated Tapered A1 Segment of the Anterior Cerebral Artery Mimicking an Anterior Communicating Artery Aneurysm

2011 ◽  
Vol 17 (2) ◽  
pp. 179-182 ◽  
Author(s):  
A.G. Weil ◽  
M.W. Bojanowski ◽  
F. Scholtes ◽  
T.E. Darsaut ◽  
F. Signorelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cerebral Artery ◽  
Computed Tomography Angiography ◽  
Anterior Cerebral Artery ◽  
Surgical Intervention ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Conventional Angiography ◽  
Hemodynamic Stress ◽  
Partially Occluded

We describe a misleading case of a partially occluded A1 segment duplication that mimicked an ACoA aneurysm on computed tomography angiography and conventional angiography and led to surgical intervention. The location of such an anomaly at the ACoA on the side of least hemodynamic stress may provide a clue to recognizing this variant.

Estimation of Profunda Artery Perforator Flap Weight Using Preoperative Computed Tomography Angiography

2020 ◽  
Vol 36 (09) ◽  
pp. 645-650
Author(s):  
Nicolas Greige ◽  
David Nash ◽  
Ara A. Salibian ◽  
Steven M. Sultan ◽  
Joseph A. Ricci ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Breast Reconstruction ◽  
Computed Tomography Angiography ◽  
Subcutaneous Tissue ◽  
Perforator Flap ◽  
Biceps Femoris ◽  
Accurate Estimation ◽  
Parsimonious Model ◽  
Artery Perforator ◽  
Gluteal Fold

Abstract Background Given the relatively small size of thigh-based flaps and the possible necessity for a multiflap reconstruction, it is imperative to arrive at an accurate estimation of flap weight during preoperative planning. It was our objective to develop a novel technique for the preoperative estimation of profunda artery perforator (PAP) flap weight. Methods All patients that underwent transverse PAP flap breast reconstruction at two institutions were retrospectively reviewed. Subcutaneous tissue thicknesses were measured on axial computed tomography angiography scans at several predetermined points. The distance from the inferior gluteal crease to the PAP was also recorded. Linear regression was used to estimate flap weight. Results A total of 18 patients (32 flaps) were analyzed. The median intraoperative flap weight was 299 g (interquartile range [IQR]: 235–408). The parsimonious model (R 2 = 0.80) estimated flap weight using the Eq. 77.9x + 33.8y + 43.4z – 254.3, where x is subcutaneous tissue thickness (cm) at the lateral border of long head of the biceps femoris at a level 4.5 cm caudal to the inferior gluteal fold, y is distance (cm) from the inferior gluteal fold to the dominant PAP, and z has a value of 1 if the patient was scanned in the supine position or 0 if prone. The aforementioned formula yielded a median estimated flap weight of 305 g (IQR: 234–402) and a median percent error of 10.5% (IQR: 6.1–16.2). Conclusion The authors demonstrate a simple and accurate formula for the preoperative estimation of transverse PAP flap weight for breast reconstruction.

Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU)

2021 ◽  
Author(s):  
John T Lindsey ◽  
Christopher Smith ◽  
James Lee ◽  
Hugo St Hilaire ◽  
John T Lindsey
Keyword(s):  
Doppler Ultrasound ◽  
Color Doppler ◽  
Vascular Anatomy ◽  
Perforator Flap ◽  
Color Doppler Ultrasound ◽  
Perforator Flaps ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Linear Array Probe ◽  
Portable Tablet

Abstract Background The first reports of using color Doppler ultrasound for evaluation of the microvasculature were in the 1990s. Despite the early reports of its efficacy, color Doppler ultrasound did not achieve popularity nor general usage in part due to the cumbersome size, cost and poor resolution. This is the first study to demonstrate the potential utility of a new, highly portable, tablet-based color Doppler ultrasound (PT-CDU) system for imaging perforator flaps. Methods The deep inferior epigastric artery (DIEP), lateral arm (LA), anterolateral thigh (ALT), thoracodorsal artery (TDAP), and the medial sural artery (MSAP) perforator flaps were imaged within classic topographic landmarks to visualize and measure variables related to perforator flap anatomy. The Philips Lumify L12–4 linear array probe attached to the Samsung Galaxy Tab A tablet was the system used for all examinations. Results A total of 216 flaps were scanned in 50 healthy adult volunteers: 44 DIEP, 44 LA, 40 ALT, 48 TDAP, and 40 MSAP. Precise anatomic information regarding perforator size, number, and location was obtained. Overall, the percent of flaps having at least 1 perforator within the specified topographical landmarks was 89% for the DIEP, 84.1% for the LA, 72.5% for the ALT, 50% for the TDAP, and 30% for the MSAP (p = 2.272e-09). The percent of patients having an asymmetry (right versus left) in the number of perforators was 72.7% (ALT), 65% (DIEP), 59.1% (LA), 41.7% (TDAP), and 30% (MSAP) (p = 0.0351). Conclusions Portable, tablet-based color Doppler ultrasound offers high-resolution images of perforators and represents a facile technology that may be of interest to microsurgeons in the planning of perforator flaps. Variations in vascular anatomy were well-demonstrated. This surgeon-driven imaging technology may represent an excellent alternative to other imaging modalities.

A clinical case of endovascular treatment of congenital intrahepatic arterioportal fistulae

2021 ◽  
Author(s):  
G. A. Dorogavtseva ◽  
E. S. Butsko ◽  
A. G. Golyaka
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Surgical Intervention ◽  
Interventional Neuroradiology ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Period ◽  
Hepatic Angiography

The development and wide use of instrumental investigational methods, including multispiral computed tomography, computed tomography with angiography, duplex scanning of blood vessels, subtraction angiography, enabled diagnosis of rare diseases, in particular, of the intrahepatic arterioportal fistulae (IAPF). Methods of surgical treatment of this pathology include both open surgery and endovascular treatment with the use of embolizing implants or coils. The article presents a clinical case of diagnosis and endovascular treatment of IAPF in a 33‑year‑old patient, hospitalized in the Center of Interventional Neuroradiology at Feofaniya Clinical Hospital. The choice of the surgical treatment was based on the account of indications and contraindications to the intervention. The endovascular method was used: exclusion of the intrahepatic arterioportal fistulae by means of implantation of micro‑coils Nester 20 мм, MReye 20 mm, Tornado 10–4 mm. Positive dynamics was observed in the long‑term postoperative period (after 3 months), the control was performed based on such criteria as complaints’ absence, normalization of laboratory parameters, positive dynamics of the data of control hepatic angiography. IAPF elimination promoted the reduction of portal hypertension, and improvement of functional liver state. Endovascular method of treatment of patients with arterioportal fistulae is the method of choice at this pathology. The advantages of endovascular method include the minimization of intraoperative and postoperative complications, the shorter postoperative rehabilitation period. In case of the necessity for other method of surgical treatment, one should follow the indications and contraindications to the surgical intervention.

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