Preoperative Angiographic Criteria for Predicting Free-Flap Transfer Outcomes in Patients With Lower-Extremity Peripheral Arterial Disease.
Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg. Angiographies with arterial abnormalities were classified into 3 groups: favorable free-flap survival, compromised free-flap survival, and postsurgical pedal ischemia. The study enrolled 50 patients between 2005 and 2013. In 42% of patients, arterial abnormalities were observed by angiography. Age >65 years was the strongest risk factor for development of lower-leg arterial abnormality ( P < .001). The anterior tibial and peroneal arteries were significantly more stenotic than other vessels. In the favorable free-flap survival and compromised free-flap survival groups, free-flap transfers were attempted in 7 patients but intraoperatively abandoned in 2 patients, with postoperative failure in 1 patient. In the postsurgical pedal ischemia group, free-flap transfers were attempted in 10 patients but intraoperatively abandoned in 6 patients, with postoperative failure in 3.
1 Department of Plastic and Reconstructive Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Sang Woo
SW
Park
2 Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea.
Junhyung
J
Kim
2 Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea.
Jaehoon
J
Choi
3 Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
Jun Sik
JS
Kim
3 Department of Plastic and Reconstructive Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
Jeong Hwan
JH
Lee
4 Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Young Sook
YS
Park
D000368:Aged; D000792:Angiography; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D007866:Leg; D007869:Leg Injuries; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures; D016909:Tibial Arteries
free flap; lower-extremity arterial disease; preoperative angiography; recipient vessel