Selective use of preoperative lower extremity arteriography in free flap reconstruction

Preoperative angiography is commonly utilized prior to free flap reconstruction of the lower extremity. The charts and radiographs of 38 patients who underwent free flap reconstruction, after acute posttraumatic lower extremity injuries, were studied. Patients were categorized according to the presence or absence of vascular abnormality based on pulse examination alone. Specific vascular abnormalities were recorded in each group. Of the 38 patients who had preoperative lower extremity arteriography, 23 were found to have normal dorsalis pedis and posterior tibial pulses. Only 1 of these patients had an angiographic abnormality. Of the 15 patients with abnormal pulse examinations, all were found to have angiographic abnormalities. Cost analysis of the lower extremity angiogram revealed a total additional expense of $2,957. Pulse examination was found to be a sensitive and effective predictor of lower extremity vascular integrity. Although lower extremity angiography is encouraged when distal pulse examination is abnormal, the use of preoperative arteriography for lower extremity microvascular free flap reconstruction is probably unnecessary in most patients with normal distal pulses.