The branching pattern of the deep inferior epigastric artery revisited in‐vivo: A new classification based on CT angiography

Abstract

The deep inferior epigastric artery (DIEA) is a reliable pedicle in the design of DIEA perforator flaps, with variations in its anatomy infrequent. Previous studies describing its branching pattern have all been based on cadaveric anatomy and described the following three branching patterns: Type 1 (single trunk), Type 2 (bifurcating trunk), and Type 3 (trifurcating trunk). The increased use of preoperative imaging, particularly with computed tomographic angiography (CTA), has enabled visualization of the DIEA and its branches in vivo, providing a functional view of this anatomy. We undertook a study of 250 patients (500 hemiabdominal walls) undergoing preoperative CTA before DIEA perforator flaps for breast reconstruction. The branching pattern of the DIEA and correlation to the contralateral hemiabdominal wall were assessed. The branching patterns of the DIEA were found to be different in vivo compared with cadaveric studies, with a higher than previously reported incidence of Type 1 patterns and lower than reported incidence of Type 3 patterns, and that some patterns exist which were not included within the previous nomenclature (namely, Type 0 or absent DIEA and Type 4 or four-trunk DIEA). There was also shown to be no overall concordance in the branching patterns of the DIEA between contralateral sides of the same abdominal wall; however, there was shown to be a statistically significant concordance in cases of a Type 1 DIEA (51% concordance, P = 0.04). As such, a new modification to the classification system for the branching pattern of the DIEA is presented based on imaging findings.

Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

“…We had postulated that this difference could be geographical as Moon and Taylor’s study was in the Australian population. However, since our data was collected a further in vivo Australian study of DIEA branching patterns in 500 hemiabdomens has been published 10 . The results appear to corroborate our findings: the researchers found a higher proportion of type 1 and a lower proportion of type 3 patterns than expected compared with Moon and Taylor’s 1988 cadaveric study.…”

Why there are two rows of deep inferior epigastric artery perforators despite variability in the number of deep inferior epigastric artery trunks: An anatomical and embryological argument

“…Of particular interest is that these two rows of perforators are distributed from the DIEA regardless of the number of major DIEA trunks (see Fig. 1), with there variably being one to four major trunks (Moon and Taylor,1988; Rozen et al,2010a). As such, a single DIEA trunk will still distribute two perforator rows, as will four major DIEA trunks.…”

“…The arcuate line is dotted; U, umbilicus. (Reproduced with permission from John Wiley & Sons, Inc. from Rozen et al (2010a) Clin Anat 23:87–92.). [Color figure can be viewed in the online issue, which is available at http://wileyonlinelibrary.com.]…”

“Choke” vessels between vascular territories of the abdominal wall: Literature review and rare case of Leriche's syndrome

“…It has long been known that the DIEA and the ITA anastomose in the abdominal wall via “choke” vessels, that is, the reduced‐caliber vessels that link adjacent vascular territories and that only dilate during times of increased demand to increase blood flow (Moon and Taylor, 1988; Rozen et al, 2010). The physiological changes that take place in choke vessels during times of hemodynamic stress could, if capable of being artificially replicated, lead to developments in the ways in which delay procedures can be, and are, performed in the abdominal wall.…”