Correlation between Abdominal Perforator Vessels Identified with Preoperative Computed Tomography Angiography and Intraoperative Fluorescent Angiography in the Microsurgical Breast Reconstruction Patient.

Abstract

Background Computed tomography angiography (CTA) has become a reliable method of perforator vessel identification. Indocyanine green laser-assisted fluorescent angiography (ICGLA) produces a real-time image of large and small caliber blood vessels. The aim of this prospective study was to compare ICGLA with CTA to evaluate its reliability of vessel identification and correlation to perforator vessel size and number determined preoperatively by CTA. The effect of both imaging techniques on flap design or intraoperative plan was also evaluated. Methods Over a 1-year period, patients presenting for free-tissue transfer breast reconstruction underwent preoperative CTA mapping of abdominal perforators followed by intraoperative ICGLA. Using visualization software, scaling factors were calculated so that CTA and ICGLA data could be compared. Results A total of 18 patients (24 breast reconstructions) were included. Larger CTA perforator size was associated with larger actual size (p = 0.04). The largest CTA perforator or largest actual perforator was used 78% of the time. Increasing body mass index was not associated with larger CTA perforator size (p = 0.67) or more intense ICGLA blushes (p = 0.13). No significant correlation was found between CTA perforator location and ICGLA skin blush location, size, or intensity. CTA- or ICGLA-guided intraoperative procedure adjustments were done in 72% of the patients. ICGLA identified poor soft tissue perfusion and guided flap resection in 46% of the patients. Conclusions ICGLA skin blush location, size, and intensity does not correlate with CTA-identified perforating vessel location or actual perforating vessel size. Despite this, the ICGLA information was useful for evaluation of soft tissue perfusion and flap design.