title: Angiographic delay:  a viable alternative to surgical delay.
abstract: BACKGROUND
  Selective embolization of the inferior epigastric arteries can serve as a method for transverse rectus abdominis musculocutaneous (TRAM) flap delay. The purpose of this study was to determine whether delay by selective arterial embolization is comparable to traditionally surgically delayed TRAM flaps as reported in the literature, in terms of skin and fat necrosis, and to examine whether certain risk factors play a role in TRAM flap fat necrosis despite angiographic delay.
  
  
  METHODS
  Retrospective chart review was performed for 88 consecutive patients who underwent unilateral TRAM flap breast reconstruction after selective embolization of bilateral inferior epigastric arteries.
  
  
  RESULTS
  Between 1997 and 2009, 88 pedicled TRAM flaps were performed for breast reconstruction in women with a mean age of 49.7 years. No patients had flap skin necrosis or total flap loss. In all, 13.6% patients had TRAM flap fat necrosis. Two patients in the TRAM fat necrosis group (16.7%) had a positive history of smoking, which was a statistically significant risk factor for necrosis (P = 0.048).
  
  
  CONCLUSIONS
  Outcomes of pedicled TRAM flaps delayed by selective arterial embolization are comparable to historical controls of those delayed by traditional surgical means (ligation of artery and vein) and better than nondelayed flaps. Smoking remains a significant risk factor for TRAM flap fat necrosis despite the benefit of delay.
authors.affiliation: Department of Plastic and Reconstructive Surgery, 9210 Forest Hill Ave., Richmond, VA 23235, USA.
authors.forename: Sharline Z
authors.initials: SZ
authors.lastname: Aboutanos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Spinos
authors.forename: Nadia P
authors.initials: NP
authors.lastname: Blanchet
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D000368:Aged; D000792:Angiography; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D015897:Comorbidity; D057210:Delayed Diagnosis; D003920:Diabetes Mellitus / Q000453:epidemiology; D004621:Embolization, Therapeutic; D019074:Epigastric Arteries / Q000000981:diagnostic imaging* / Q000601:surgery*; D005218:Fat Necrosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D008323:Mammary Arteries / Q000000981:diagnostic imaging; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D017568:Rectus Abdominis / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013524:Surgical Flaps; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome