The inferior epigastric artery is an important artery of the abdominal wall and arises from the external iliac artery and passes up via the transversalis fascia to the arcuate line where is pierces the rectus abdominis. Superiorly the rectus abdominis is supplied by the superior epigastric artery, a continuation of the internal thoracic artery.
Imaging of these arteries is frequently performed prior to breast reconstruction. Previously more common transverse rectus abdominis myocutaneous (TRAM) flaps are being replaced by deep inferior epigastric artery (DIEA) or deep inferior epigastric artery perforator (DIEP) flaps due to lower complications associated, especially with the latter1-3. Preoperative evaluation by angiography has been shown to reduce the time of surgery and may have an effect on complications4.
CT angiography is now the preferred method of imaging the inferior epigastric vessels, superior to US when used preoperatively in breast reconstruction5, but with the disadvantage of ionizing radiation. Despite a possible dose as low as 6mSv6 using CT, MR is being investigated to assess the inferior epigastric vessels7.
Three images of the inferior epigastric arteries are shown above.
1. Coronal MIP demonstrating the normal course of the inferior epigastric arteries.
2. Thick slab axial MIP image demonstrating the deep inferior epigastric artery perforator branches.
3. The inferior epigastric vessels (colour) within the rectus abdominis.
1. MINQIANG X, LANHUA M, JIE L, DALI M, JINGUO L. The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps. Br J Radiol. 2009:29140440.
2. Ghattaura A, Henton J, Jallali N, et al. One hundred cases of abdominal-based free flaps in breast reconstruction. The impact of preoperative computed tomographic angiography. Journal of Plastic, Reconstructive & Aesthetic Surgery. In Press, Corrected Proof. Available at: http://www.sciencedirect.com/science/article/B7XNJ-4XR60NK-1/2/d1466f93a91f8e3ce93543fa49f27d61 [Accessed March 27, 2010].
3. Phillips TJ, Stella DL, Rozen WM, Ashton M, Taylor GI. Abdominal Wall CT Angiography: A Detailed Account of a Newly Established Preoperative Imaging Technique1. Radiology. 2008;249(1):32-44.
4. Smit JM, Dimopoulou A, Liss AG, et al. Preoperative CT angiography reduces surgery time in perforator flap reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2009;62(9):1112-1117.
5. Rozen WM, Phillips TJ, Ashton MW, et al. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast. Reconstr. Surg. 2008;121(1):9-16.
6. Rozen WM, Whitaker IS, Stella DL, et al. The radiation exposure of Computed Tomographic Angiography (CTA) in DIEP flap planning: low dose but high impact. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2009;62(12):e654-e655.
7. Neil-Dwyer J, Ludman C, Schaverien M, McCulley S, Perks A. Magnetic resonance angiography in preoperative planning of deep inferior epigastric artery perforator flaps. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2009;62(12):1661-1665.