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Mapping the Superficial Inferior Epigastric System and its Connection to the Deep System: An MRA Analysis
David E. Kurlander, MD1, Matthew Brown, MD1, Rodrigo A. Iglesias, BS, MS, MBA1, Hooman T. Soltanian, MD2.
1Case Western Reserve University, Cleveland, OH, USA, 2University Hospitals Case Medical Center, Cleveland, OH, USA.

PURPOSE:
The superficial inferior epigastric vasculature plays a critical role in free abdominal tissue transfer. Its anatomic variations are incompletely characterized and may be associated with risk of postoperative complications.
METHODS:
Preoperative imaging from all patients undergoing free flap breast reconstruction by a single surgeon (HTS) from 2008-2013 was examined. Patients receiving abdominal magnetic resonance angiogram (MRA) were included for analysis. The main artery and primary branches from each patient’s superficial inferior epigastric system were drawn onto a coordinate system. Each hemiabdomen’s branching pattern was categorized as simple, complex, or absent. Numbers of deep-superficial inferior epigastric connections and presence or absence of a superficial system crossing midline were recorded.
RESULTS:
Fifty-three patients (106 hemiabdomens) were included for analysis. Seventy-six percent of hemiabdomens were categorized as having simple and 10% as complex branching patterns. Fifteen percent of hemiabdomens had no identifiable vessels. Eighty-nine hemiabdomens (84%) had at least 1 superficial-to-deep connection. Fourteen patients (26%) had superficial systems crossing the midline.
CONCLUSION:
Our findings support the high degree of anatomic variation in the superficial inferior epigastric system, including a significant number of patients lacking superficial-to-deep connections and bilaterally communicating systems. These variations may be associated with risk for venous congestion and may be identified on preoperative MRA.


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