title: Magnet Resonance Angiography versus Conventional Angiography for the Planning of Reconstructive Surgeries.
abstract: Assessing the vascular status and anatomy of the lower extremity is of crucial importance when planning the coverage of a tissue defect with a free flap. The standard techniques comprise the clinical examination, Doppler ultrasound and Doppler sonography for healthy patients without suspected direct trauma to the vascular system, and conventional digital subtraction angiography (DSA), respectively, in case of traumatized vessels or patients with peripheral arterial obstructive disease.
  
  
  METHODS
  We have conducted a prospective study for the comparison of the magnetic resonance angiography (MRA) to the conventional DSA. Fourteen patients were examined presurgically by means of both a conventional DSA and an MRA before undergoing planned microvascular coverage of tissue defects of the lower extremity. The surgeon, based on a questionnaire, assessed and compared both examination results according to their information content. Furthermore, the presurgically planned level and localization of the vascular anastomoses and the intraoperative findings were compared postoperatively.
  
  
  RESULTS
  The MRA examination yielded sufficient information on the vascular anatomy to enable the surgeon to carry out a detailed presurgical planning. Additionally, the use of MRA showed clear advantages with regard to both patient and user comfort.
  
  
  CONCLUSIONS
  Taking into account the advantages for the assessment of vessels using MRA, in particular when considering the impact of the frequently varying vascular anatomy of the lower leg on reconstructive surgery, as well as the significantly lower morbidity rate of the examination itself, then the MRA must be regarded as a safe alternative to the DSA.
authors.affiliation: Division for Plastic, Hand and Reconstructive Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Köhler
authors.affiliation: Institute of Diagnostic Radiology, University Hospital, Zurich, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Weishaupt
authors.affiliation: Division for Plastic, Hand and Reconstructive Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Merlin
authors.initials: M
authors.lastname: Guggenheim
authors.affiliation: Division for Plastic, Hand and Reconstructive Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Künzi
authors.affiliation: Division for Plastic, Hand and Reconstructive Surgery, University Hospital, Zurich, Switzerland. volker.wedler@usz.ch.|Division for Plastic, Hand and Reconstructive Surgery, University Hospital of Zurich, Rämistrasse 100, 8094, Zurich, Switzerland. volker.wedler@usz.ch.
authors.forename: Volker
authors.initials: V
authors.lastname: Wedler
keywords: Lower limb injuries; Microsurgery; Plastic and reconstructive surgery; Vascular trauma