Evaluating the utility of CT angiographic reports for evaluation of deep inferior epigastric artery in preparation for DIEP flap breast reconstruction surgery

Purpose Accurate preoperative evaluation of the deep inferior epigastric artery is essential for maximizing surgical outcomes in deep inferior epigastric perforator (DIEP) flap procedures. This study aims to compare CT angiographic (CTA) findings with surgical observations of DIEP flaps to address surgical requirements and enhance surgical flap selection for breast reconstructions by through optimized radiology reports. Methods A retrospective review of 44 CTA studies at a single institution between January 2021 and March 2023 was conducted. Two readers independently assessed DIEP anatomy in CTAs. Electronic medical records were reviewed for surgical indications and operative findings. Descriptive statistics and interrater reliability were used. Results Patient ages ranged from 30 to 71. Both readers agreed on good CTA quality in 75% of cases. Bilateral flap reconstruction was performed on 21 patients, while 12 had unilateral reconstruction. Eleven subjects had not undergone breast reconstruction at the time of this study. Postoperative complications (flap necrosis) occurred in four flaps. Moderate interrater agreement was seen for DIEP branching, perforator number, and diameter (0.4 ≤ κ ≤ 0.6). Conclusion For optimal flap selection, radiology reports should include up to four DIEP perforators >1.5-mm-thick below the umbilical level and at the subfascial plane. This is crucial for successful flap reconstruction and reducing complications related to unexpected aberrant anatomy during surgical flap dissection. Improving radiology report quality is vital to assist surgeons in selecting abdominally based flaps for breast reconstruction. Level of Evidence: Level IV, Risk - Prognostic Study.