title: Role of computed tomography angiography in the diagnosis of vascular stenosis in head and neck microvascular free flap reconstruction.
abstract: The aim of this study was to evaluate the role of computed tomography angiography (CTA) in the diagnosis of vascular stenosis at the vascular pedicle of head and neck microvascular free flaps. A prospective study was done of 65 consecutive patients (49 male, 16 female; mean age 55 years) who had undergone head and neck microvascular free flap reconstruction. All patients underwent 64-slice CTA of the carotid artery. Post-processing with volume rendering reconstruction of CTA images was done. There was excellent inter-observer agreement (weighted kappa=0.82, 95% confidence interval (CI) 0.74-0.93) in grading of the degree of vascular stenosis. The true sensitivity of CTA for diagnosis of stenosis of the vascular pedicle to the flap was 63% (95% CI 63-100%). Patients with failed flaps showed complete occlusion (n=2) on CTA and underwent a replacement flap procedure. Patients with failing flaps showed severe stenosis (n=6) of the vascular pedicle on CTA and underwent revision surgery. There was no change in the degree of stenosis on follow-up CTA for patients with moderate stenosis (n=9). CTA is a reliable, non-invasive, high-quality imaging tool for the diagnosis and grading of vascular stenosis of the vascular pedicle of head and neck microvascular free flaps.
authors.affiliation: Department of Diagnostic Radiology, Mansoura University, Mansoura, Egypt. Electronic address: arazek@mans.edu.eg.
authors.forename: A A K
authors.initials: AA
authors.lastname: Abdel Razek
authors.affiliation: Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt.
authors.forename: A T
authors.initials: AT
authors.lastname: Denewer
authors.affiliation: Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt.
authors.forename: M A F
authors.initials: MA
authors.lastname: Hegazy
authors.affiliation: Surgical Oncology Unit, Oncology Center, Mansoura University, Mansoura, Egypt.
authors.forename: M T A
authors.initials: MT
authors.lastname: Hafez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D019651:Plastic Surgery Procedures; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: CT; flap; head and neck; stenosis; vascular