Ankle-Arm Index versus Angiography for the Preassessment of the Fibula Free Flap

Abstract

Peripheral arterial occlusive disease or congenital anomalies of the major crural arteries may limit the use of the fibula free flap and should be detected preoperatively. Conventional selective angiography is the definitive standard imaging method for making this diagnosis, but it has drawbacks. A safer, cheaper, more accurate, and noninvasive alternative is desirable. The authors sought to test the hypothesis that the ankle-arm index of each of the three crural arteries, combined with pencil Doppler examination of the peroneal skin perforators, would provide adequate information to restrict the use of angiography to cases in which the outcomes of either or both of these options are insufficient. The ankle-arm index data of each of the three crural arteries, as well as pencil Doppler examination of the peroneal skin perforators of both legs of nine prospectively included patients and the nonoperated legs of 13 retrospectively included patients, were compared statistically in four different ways with the preoperative angiographic findings. A combined ankle-arm index and pencil Doppler examination is not accurate enough to detect legs or arteries with subclinical peripheral arterial occlusive disease or vascular variation and, hence, is not a sufficient basis on which to develop the surgical plan for a fibula free flap.

Devascularizing Complications of Free Fibula Harvest: Peronea Arteria Magna

“…A 10-cm segmental bony defect of the radius was reconstructed with a free fibula osteofasciocutaneous flap (Figs. [1][2][3][4]. No preoperative donor-leg angiography was performed.…”

Time-Resolved and Bolus-Chase MR Angiography of the Leg: Branching Pattern Analysis and Identification of Septocutaneous Perforators

“…History and physical examination are considered important aspects of the evaluation [25]. Examination of pedal pulses [25] and the ankle–arm index [26, 27] can be reliably used to detect occlusive lesions. However, the presence of congenital vascular variations necessitates preoperative imaging [27].…”

“…Examination of pedal pulses [25] and the ankle–arm index [26, 27] can be reliably used to detect occlusive lesions. However, the presence of congenital vascular variations necessitates preoperative imaging [27]. Digital subtraction angiography has been considered the reference standard for preoperative analysis in the care of these patients [7], but this invasive procedure yields only 2D images, does not depict septocutaneous perforators, entails exposure to ionizing radiation, and is associated with a small but definite rate of complications [1, 5, 28].…”

Intra-Operative Acute Leg Ischaemia after Free Fibula Flap Harvest for Mandible Reconstruction

“…Even performing an ankle-arm index measurement, as published by KLEIN and HAGE in 2003, is not enough (13). The authors tested the hypothesis that the ankle-arm index of each of the three crural Proximal and distal anastomosis of the popliteo-peroneal bypass.…”