Predictive Value of SIEV Caliber and Superficial Venous Dominance in Free DIEP Flaps

Kw, Sadik; Pasko, Jennifer; Cohen, Arthur H.; Cacioppo, Jason R.

doi:10.1055/s-0032-1326743

Cited by 7 publications

(9 citation statements)

References 6 publications

(10 reference statements)

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“…That corresponds with our clinical experience as well. However, a study of 39 DIEP flaps showed no correlation between the radiographic size or the in situ size of the SIEV, the BMI, the age or the BMI:SIEV size ratio and the need for SIEV use ( 92 ).…”

Section: Discussionmentioning

confidence: 99%

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

et al. 2023

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BackgroundAutologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV).Methods150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated.ResultsIn a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred.ConclusionsUse of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.

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Section: Discussionmentioning

confidence: 99%

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

et al. 2023

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“…In patients in whom venous congestion develops despite a patent DIEV anastomosis (approximately 2 percent), the SIEV system is critical. 14 Unfortunately, it is difficult to predict, preoperatively, who will need a superficial vein–only DIEP or dual venous drainage (SIEV plus DIEV) flap. Although some studies suggest that imaging modalities can assist in this determination by examining the vessels’ anatomical characteristics, others find that these characteristics are not predictive of venous congestion or the need to use the SIEV.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Although some studies suggest that imaging modalities can assist in this determination by examining the vessels' anatomical characteristics, others find that these characteristics are not predictive of venous congestion or the need to use the SIEV. [14][15][16][17][18] Intraoperative measures, such as monitoring SIEV pressure to gauge superficial venous system dominance or measuring blood glucose indices of the flap to assess venous congestion, have been described but may not always be practical or available. 19,20 We believe clinical evaluation, assessing flap color and capillary refill, and "tautness" of the SIEV stump when occluded with an Acland clamp, have proven the most helpful, efficient, and cost-effective methods in determining the need to use the SIEV.…”

Section: Ementioning

confidence: 99%

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The Superficial Vein Only (SVO)-DIEP Flap

Nigro

Shankaran

Miller

2022

Plastic &Amp; Reconstructive Surgery

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Background: The deep inferior epigastric artery perforator (DIEP) flap, often considered the standard in autologous breast reconstruction, is reliant on robust arterial inflow and venous outflow. Venous outflow issues remain a critical part in determining the success of the DIEP flap. Previously, the superficial inferior epigastric vein (SIEV) has been used to augment venous outflow, or as a salvage option when flow through the deep inferior epigastric vein is compromised or insufficient. The authors describe a variant of the DIEP flap, the superficial vein–only DIEP flap, using the deep inferior epigastric artery and the SIEV as a viable alternative when indicated. Methods: The authors conducted a retrospective review of all patients undergoing autologous breast reconstruction performed by the senior author (B.C.) from July of 2015 to March of 2020 to identify DIEP flaps whose only source of venous outflow was the SIEV, excluding those performed as salvage maneuvers. Results: The authors identified 30 patients (35 flaps) and describe their characteristics, flap characteristics, complications, and details of the flap harvest. Notably, the authors experienced complications in 26.7 percent of flaps, of which 62.5 percent were minor, with no flap loss. This was comparable to the complication rate observed in the standard DIEP flap population. Conclusions: The authors believe the superficial vein–only DIEP flap is an excellent option for the appropriate patient. It is an added tool to make abdominally based breast reconstruction more reliable and successful. The use of the SIEV in a superficial vein–only flap should be considered as part of any routine DIEP flap reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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“…Flap complications O4. Operative time − − − Sadik, 2013, USA [ 50 ] Definition of predictors for a superficially dominant venous system Non-randomised study (prospective) with controls P1: 39 DIEPs I1: 6 C: 33 I4: CTA—measurement of the SIEV diameter preoperatively. The diameter was also measured intraoperatively NR NR O6.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps

Hansson,

Ramakrishnan,

Morgan

2023

World J Surg Onc

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Background Abdominally based free flaps are commonly used in breast reconstruction. A frequent complication is venous congestion, which might contribute to around 40% of flap failures. One way to deal with it is venous supercharging. The primary aim of this study was to investigate the scientific evidence for the effects of venous supercharging. Methods A systematic literature search was conducted in PubMed, CINAHL, Embase, and Cochrane library. The included articles were critically appraised, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Results Thirty-six studies were included. Most studies had serious study limitations and problems with directness. Three studies report ‘routine’ use of venous supercharging and performed it prophylactically in patients who did not have clinical signs of venous congestion. Seventeen studies report on flap complications, of which one is a randomised controlled trial demonstrating statistically significant lower complication rates in the intervention group. The overall certainty of evidence for the effect of a venous supercharging on flap complications, length of hospital stay and operative time, in patients without clinical signs of venous congestion, is very low (GRADE ⊕ ⊕ ⊝ ⊝), and low on and surgical takebacks (GRADE ⊕ ⊕ ⊝ ⊝). Twenty-one studies presented data on strategies and overall certainty of evidence for using radiological findings, preoperative measurements, and clinical risk factors to make decisions on venous supercharging is very low (GRADE ⊕ ⊝ ⊝ ⊝). Conclusion There is little scientific evidence for how to predict in which cases, without clinical signs of venous congestion, venous supercharging should be performed. The complication rate might be lower in patients in which a prophylactic venous anastomosis has been performed. Trial registration PROSPERO (CRD42022353591).

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Predictive Value of SIEV Caliber and Superficial Venous Dominance in Free DIEP Flaps

Cited by 7 publications

References 6 publications

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

The Superficial Vein Only (SVO)-DIEP Flap

A systematic review of the scientific evidence of venous supercharging in autologous breast reconstruction with abdominally based flaps

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