The Utility of Preoperative Arteriography for Free Flap Planning in Patients with Chronic Lower Extremity Wounds

Background: In patients with lower extremity wounds, free tissue transfer is often the last option before amputation, making it crucial to optimize preoperative planning in order to prevent flap breakdown. No consensus exists regarding preoperative vascular work ups before lower extremity free tissue transfer. Here we analyzed the utility of using arteriography for lower extremity free flap planning. Methods: A retrospective review was performed of 57 patients who underwent lower extremity arteriography and 59 free flap operations for lower extremity wounds between November 2014 and August 2017. Findings were used to guide flap recipient vessel selection. Arterial pathology was addressed via endovascular intervention, where appropriate. Encountered pathology was described and patient demographics, comorbidities, and outcomes were analyzed for correlation with abnormal angiographic studies. Results: Angiographic abnormalities were observed in 40 patients (67.8%), including 23 (57.5%) with stenosis/occlusion, 20 (50.0%) with atretic/non-visualized vessels, and 11 (27.5%) requiring endovascular intervention. Stenosis/occlusion was detected in 9 patients (15.3%) with no previously known arterial disease, leading to a new diagnosis of peripheral vascular disease. Flap survival rate was 98.3%, 6 patients (10.2%) ultimately progressed to amputation, and 53 patients (89.8%) were able to continue community ambulation at a mean follow-up time of 15.1 months (SD 9.51, range 1.67–35.2). After arteriography, 2 patients (3.39%) suffered contrast-induced acute kidney injury. No other complications were noted. Conclusions: Preoperative lower extremity arteriography aids in the diagnosis of peripheral vascular disease, allows for timely endovascular intervention, and allows for optimal flap recipient vessel selection with a low complication rate. Financial Disclosure: There are no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report for any of the above authors. Presentations: Preliminary study results presented at the 2017 American Society for Reconstructive Microsurgery Annual Meeting. January 15, 2017, Kona, HI. Corresponding Author: Karen Kim Evans, MD, Associate Professor, Department of Plastic and Reconstructive Surgery, 3800 Reservoir Road NW, Center for Wound Healing and Hyperbaric Medicine, 1st Floor, Bles Building, Washington, DC 20007, Phone: (202) 444-3059, Fax: (202) 444-0300, Email: karen.k.evans@gunet.georgetown.edu ©2018American Society of Plastic Surgeons

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