The Supraclavicular Artery Perforator Flap: A Comparative Study of Imaging Techniques Used in Preoperative Mapping.

BACKGROUND: The supraclavicular artery flap is an excellent flap for head and neck reconstruction. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap. METHODS: Six imaging techniques were used for supraclavicular artery mapping in 65 cases; handheld Doppler, triplex ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, and indocyanine green angiography. We checked the site of the perforators, the course of a supraclavicular artery, and anatomical mapping of the supraclavicular artery. RESULTS: Handheld Doppler identified perforators' sites in 80% of the cases but showed no results for the course of the vessel. Triplex ultrasound identified the site of perforators in 52.9%, and partial mapping of the course of a supraclavicular artery in 64.7% of the cases. Computerized tomography angiography showed the site of perforators in 60%, and the course of supraclavicular artery completely in 45%, and partially in an additional 30%of the cases examined. Magnetic resonance angiography showed negative results for all parameters. Digital subtraction angiography showed the partial course of a supraclavicular artery in 62.5%, but showed no perforators. Indocyanine green angiography showed the site of perforators in 60% and a partial course of supraclavicular artery distal to perforators in 60%.Anatomical mapping of the vessel was possible with computerized tomography angiogram completely in 45%, and partially in 30%, and was also possible with indocyanine green angiography partially in 60%. CONCLUSION: Computerized tomography angiography showed best results in the mapping of the supraclavicular artery, but with an inability to define the perforator perfusion territories, and also with risks of irradiation, while indocyanine green angiography is a good alternative as it could precisely map the superficial course of the artery and angiosomes, with no radiation exposure.

Coronary artery perforation complicating percutaneous coronary intervention.

Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation. Mean age was 60 ± 9.2 years (range 40-74 years). Standard diagnostic angiography or percutaneous interventions were performed. Coronary artery perforation was diagnosed by worsening of symptoms, hypotension, or angiographic evidence of type I (extraluminal crater), II (myocardial or pericardial blushing), or III (contrast streaming or cavity spilling) perforation. Stenosis was graded as >85%, 60%-85%, or < 60%. Once coronary artery perforation was diagnosed, heparin was reversed, antiplatelets were stopped, and pericardial effusions were aspirated. Type II and III coronary artery perforations were sealed using covered stents or repeated brief balloon inflations. Results The most frequently injured artery was the left anterior descending ( n = 14, 58.3%). Type II and III coronary artery perforations constituted the majority ( n = 18, 75%). Thirteen (54.2%) patients had severe coronary stenosis. Perforations were caused by stents ( n = 10), angioplasty wires ( n = 8), and balloons ( n = 6). Fifteen perforations were sealed with covered stents, 2 by balloon inflations, and 7 resolved spontaneously. Pericardial effusion was drained in 13 (54.2%) patients. No patient required surgery, and none died. Conclusion The low rate and early management of coronary artery perforations, mainly by covered stents, were the hallmarks of this study.