CTA与多普勒筛查腓动脉变异的临床影像学研究

doi:10.19438/j.cjoms.2021.03.016

中国口腔颌面外科杂志 ›› 2021, Vol. 19 ›› Issue (3): 262-269.doi: 10.19438/j.cjoms.2021.03.016

CTA与多普勒筛查腓动脉变异的临床影像学研究

马春跃¹, 田卓炜¹, 朱丹², 秦兴军¹

1.上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011;
2.上海交通大学医学院附属第九人民医院放射科,上海 200011

收稿日期:2020-10-19 修回日期:2021-01-20 发布日期:2021-07-16
通讯作者: 秦兴军,E-mail:qinxj1989@sina.com
作者简介:马春跃（1984-）,男,博士,主治医师,E-mail:maxifama@163.com
基金资助:
上海市自然科学基金（19ZR1430000）; 上海市卫生健康委员会基金青年项目（20194Y0017）; 上海交通大学医学院附属第九人民医院创客及交叉基金（JYJC201911、CK2019004）

A retrospective study comparing CT angiography and ultrasonic doppler prior to vascularized fibular harvest

MA Chun-yue¹, TIAN Zhuo-wei¹, ZHU Dan², QING Xing-jun¹

1. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology. Shanghai 200011;
2. Department of Radiology, Shanghai Nith People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2020-10-19 Revised:2021-01-20 Published:2021-07-16

摘要/Abstract

摘要： 目的通过分析血管化腓骨肌皮瓣制备前及制备中发现的腓动脉变异情况,探讨大型血管化游离腓骨肌皮瓣制备前选择性使用CT血管造影技术（computed tomography angiography,CTA）的必要性。方法回顾性收集单中心近10年经CTA或术中发现的各类腓动脉变异情况,分析不同腓动脉血管的分类及分布情况。结果在683例计划腓骨瓣手术患者中,16例（19侧）发现小腿腓动脉异常,其中3例为双侧腓动脉变异。在2侧小腿中发现ⅢC型变异（腓大动脉变异型）,而大多数变异（13侧小腿）为ⅢA型（胫后动脉发育不良或缺失型）;4侧小腿为新ⅢD型（胫、腓动脉低分叉型）。术前多普勒超声及体格检查仅发现2侧小腿血管异常。这些患者中,6例因制备腓骨瓣术中发现变异（术前仅做了超声及体格检查）,其中3例继续切取腓骨瓣,并采用动脉血管桥接的方法以延长腓动脉,其中1例术后出现小腿局部组织缺血、比目鱼肌部分坏死和跛行。结论为确保腓骨瓣制备后的下肢供区安全,倡导选择性地在制备长段复杂性腓骨瓣手术前进行CTA检查,而不是单纯采用多普勒超声检查。

关键词: 腓骨瓣, 腓动脉, 变异, CTA

Abstract: PURPOSE: This study was aimed to discuss and propose the necessity of selective use of CT angiography(CTA) before vascularized fibular flap harvest. METHODS: A 10-year retrospective analysis was performed to find the patients with various fibular artery(FA) abnormalities confirmed by CTA or intraoperative findings. Different FA abnormalities and their influences on peri- or intra-operative decisions were summarized. RESULTS: A total of 19 FA anomalies were found either pre- or intra-operatively in 16 patients, with 3 cases having bilateral FA anomalies. FA magna was confirmed in 2 legs, while the majority (13 legs) were with type ⅢA hypoplastic/aplastic posterior tibialis arteries, 4 legs with typeⅢD (low bifurcation). Preoperative color doppler ultrasonography(CDU) only suspected anomalies in 2 legs. Six cases proceeded with using the affected fibulas, within whom vascular grafts were used in 3 for lengthening the pedicle of FA. Two cases changed into soft tissue flaps instead of fibular flap intraoperatively. Reconstructive plans changed preoperatively for the other 8 cases, into soft-tissue free flaps, iliac bone flaps or adjacent flaps for 5, 2 and 1 retrospectively. Local ischemia, partial soleus muscle necrosis and claudication was found in 1 patient. CONCLUSIONS: CTA should be performed selectively for screening contraindications for lengthy fibular flaps when necessary.

Key words: Fibular flaps, Fibular artery, Anomaly, CT angiography

中图分类号:

R782.2

马春跃, 田卓炜, 朱丹, 秦兴军. CTA与多普勒筛查腓动脉变异的临床影像学研究[J]. 中国口腔颌面外科杂志, 2021, 19(3): 262-269.

MA Chun-yue, TIAN Zhuo-wei, ZHU Dan, QING Xing-jun. A retrospective study comparing CT angiography and ultrasonic doppler prior to vascularized fibular harvest[J]. China J Oral Maxillofac Surg, 2021, 19(3): 262-269.

参考文献

[1] Awad ME, Altman A, Elrefai R, et al.The use of vascularized fibula flap in mandibular reconstruction; a comprehensive systematic review and meta-analysis of the observational studies[J]. J Craniomaxillofac Surg, 2019, 47(4): 629-641.
[2] Chow LC, Napoli A, Klein MB, et al.Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation[J]. Radiology, 2005, 237(1): 353-360.
[3] Gryseleyn R, Schlund M, Pigache P, et al.Influence of preoperative imaging on fibula free flap harvesting[J]. J Stomatol Oral Maxillofac Surg, 2017, 118(5): 265-270.
[4] Saydam FA, Basaran K, Ceran F, et al.Foot ischemia after a free fibula flap harvest: immediate salvage with an interpositionalsapheneous vein graft[J]. J Craniofac Surg, 2014, 25(5): 1784-1786.
[5] Lutz BS, Wei FC, Ng SH, et al.Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases[J]. Plast Reconstr Surg,1999,103(1):121-127.
[6] Disa JJ, Cordeiro PG.The current role of preoperative arteriography in free fibula flaps[J]. Plast Reconstr Surg, 1998, 102(4): 1083-1088.
[7] Alolabi N, Dickson L, Coroneos CJ, et al.Preoperative angiography for free fibula flap harvest: a meta-analysis[J]. J Reconstr Microsurg,2019,35(5): 362-371.
[8] Wales CJ, Morrison J, Drummond R, et al.Pre-operative evaluation of vascularised fibula donor sites: a UK maxillofacial e-survey[J]. Br J Oral Maxillofac Surg, 2010, 48(3): 192-194.
[9] Ahmad N, Kordestani R, Panchal J, et al.The role of donor site angiography before mandibular reconstruction utilizing free flap[J]. J Reconstr Microsurg, 2007, 23(4): 199-204.
[10] Kim D, Orron DE, Skillman JJ.Surgical significance of popliteal arterial variants. A unified angiographic classification[J]. Ann Surg, 1989, 210(6): 776-781.
[11] Kil SW, Jung GS.Anatomical variations of the popliteal artery and its tibial branches: analysis in 1242 extremities[J]. Cardiovasc Intervent Radiol, 2009, 32(2): 233-240.
[12] Tan BK, Wong CH, Chen HC.Anatomic variations in head and neck reconstruction[J]. Semin Plast Surg, 2010, 24(2): 155-170.
[13] Day CP, Orme R.Popliteal artery branching patterns-an angiographic study[J]. Clin Radiol, 2006, 61(8): 696-699.
[14] Kropman RH, Kiela G, Moll FL, et al.Variations in anatomy of the popliteal artery and its side branches[J]. Vasc Endovascular Surg, 2011, 45(6): 536-540.
[15] Jung W, Oh CS, Won HS, et al.Unilateral arteria peronea magna associated with bilateral replaced dorsalis pedis arteries[J]. Surg Radiol Anat, 2008, 30(5): 449-452.
[16] Longo B, Sorotos M, Nicolotti M, et al.Retrospective analysis of incidence of peroneal artery hypoplasia in 101 free fibula transfers and new classification of popliteal branch anomalies[J].Injury, 2014, 45(2): 394-398.
[17] Quain R.Anatomy of the arteries of the human body[M]. London:Taylon&Walton,1844: 415-422.
[18] Dubreuil-Chambardel.Variations des Artères du Pelvis et du MembreInférieur[M]. Paris: Masson,1925.
[19] Tomaszewski KA, Popieluszko P, Graves MJ, et al. The evidence-based surgical anatomy of the popliteal artery and the variations in its branching patterns [J]. J Vasc Surg, 2017, 65(2): 521-529.e6.
[20] Abou-Foul AK, Borumandi F.Anatomical variants of lower limb vasculature and implications for free fibula flap: systematic review and critical analysis[J]. Microsurgery, 2016, 36(2): 165-172.
[21] Kelly AM, Cronin P, Hussain HK, et al.Preoperative MR angiography in free fibula flap transfer for head and neck cancer: clinical application and influence on surgical decision making[J]. AJR Am J Roentgenol, 2007, 188(1): 268-274.
[22] Hölzle F, Ristow O, Rau A, et al.Evaluation of the vessels of the lower leg before microsurgical fibular transfer. Part I: anatomical variations in the arteries of the lower leg[J]. Br J Oral Maxillofac Surg, 2011, 49(4): 270-274.
[23] Dinh T, Scovell S, Veves A.Peripheral arterial disease and diabetes: a clinical update[J]. Int J Low Extrem Wounds, 2009, 8(2): 75-81.
[24] Bernstein O, Chalmers N.New treatments for infrapopliteal disease: devices, techniques, and outcomes so far[J]. Cardiovasc Intervent Radiol, 2012, 35(4): 715-724.
[25] Mustapha JA, Diaz-Sandoval LJ, Saab F.Infrapopliteal calcification patterns in critical limb ischemia: diagnostic, pathologic and therapeutic implications in the search for the endovascular holy grail[J]. J Cardiovasc Surg (Torino), 2017, 58(3): 383-401.
[26] Met R, Bipat S, Legemate DA, et al.Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis[J]. JAMA, 2009, 301(4): 415-424.
[27] Rosson GD, Singh NK.Devascularizing complications of free fibula harvest: peronea arteria magna[J]. J Reconstr Microsurg, 2005, 21(8): 533-538.
[28] Lorenz RR, Esclamado R.Preoperative magnetic resonance angiography in fibular-free flap reconstruction of head and neck defects[J]. Head Neck,2001,23(10): 844-850.
[29] Smith RB, Thomas RD, Funk GF.Fibula free flaps: The role of angiography in patients with abnormal results on preoperative color flow Doppler studies[J]. Arch Otolaryngol Head Neck Surg, 2003, 129(7): 712-715.

CTA与多普勒筛查腓动脉变异的临床影像学研究

A retrospective study comparing CT angiography and ultrasonic doppler prior to vascularized fibular harvest

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