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Ruiz-Moya et al. Plast Aesthet Res 2017;4:127-34 Plastic and
DOI: 10.20517/2347-9264.2017.29
Aesthetic Research

www.parjournal.net
Original Article Open Access

Anatomical features associated with venous

congestion in DIEP flap using CT angiography

with three-dimensional reconstruction

Alejandro Ruiz-Moya , Rafael-Antonio Lopez-Garcia , Domingo Sicilia-Castro , Tomas Gomez-Cia ,
1
1
1
1
Pedro Infante-Cossio 2
1 Department of Plastic and Reconstructive Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain.
2 Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain.
Correspondence to: Dr. Pedro Infante-Cossio, Department of Surgery, School of Medicine, University of Seville, Av. Dr. Fedriani, 41009 Seville,
Spain. E-mail: pinfante@us.es

How to cite this article: Ruiz-Moya A, Lopez-Garcia RA, Sicilia-Castro D, Gomez-Cia T, Infante-Cossio P. Anatomical features associated with venous
congestion in DIEP flap using CT angiography with three-dimensional reconstruction. Plast Aesthet Res 2017;4:127-34.

Dr. Alejandro Ruiz-Moya is a plastic surgeon presently working as consultant at the Virgen del Rocio University
Hospital, Seville, Spain. He obtained his medical degree from the University of Cantabria, Spain, and fulfilled his
Plastic, Reconstructive and Aesthetic residency program in the Virgen del Rocio University Hospital, Seville, Spain.
His areas of interest are breast surgery, lower extremity reconstruction and microsurgery. He has published 5
international peer-reviewed articles and book chapters.

ABSTRACT
Article history: Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual
Received: 12-04-2017 reconstruction has been increasingly used in planning deep inferior epigastric artery
Accepted: 20-07-2017 perforator (DIEP) breast reconstruction. Although the most common complication
Published: 21-08-2017 associated with this surgery is diffuse venous congestion, its origin remains unclear. The
aim of this study was to assess the anatomical characteristics of the anterior abdominal wall
Key words: vessels that could predict venous congestion, using CTA with 3D virtual reconstruction.
Deep inferior epigastric artery Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps
perforator, were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with
flap, regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases
venous congestion, were identified. For each case, 3 controls that had not exhibited any vascular complications
breast reconstruction, were randomly selected. Results: The global venous congestion rate was 4.14%. No
computed tomography statistically significant differences were found between the groups’ superficial inferior
epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371),
angiography, number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652),
preoperative imaging, direct communications between SIEV-perforators (P = 0.418), and communications of both
virtual reality SIEVs across the abdominal midline (P = 0.371). Conclusion: The present study provided

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