Journal of Plastic, Reconstructive & Aesthetic Surgery
Macrovascular arteriovenous shunts (MAS): A newly identified structure in the abdominal wall with implications for thermoregulation and free tissue transfer
Section snippets
Methods
A clinical study reviewing 140 preoperative CTA imaging studies of the abdominal wall vasculature was undertaken. These comprised consecutive patients undergoing deep inferior epigastric artery (DIEA) perforator flaps for breast reconstruction during the period between January 2006 and October 2008. All patients were recruited and imaged at a single institution. All patients were female, spanned a range of body habitus types, and were between the ages of 30–70.
A single imaging protocol was used
Results
Upon review of all 140 CTA imaging studies, it was found that the SIEV was contrast filled in all cases. In 137 cases, all cutaneous arteries (DIEA, DIEA perforators and the SIEA) were contrast filled and the only contrast-filled cutaneous vein was the SIEV. In the remaining 3 cases, the DIEV was also filled with contrast.
This phenomenon is highlighted in Figure 1, in which the cutaneous arteries are shown to be contrast-filled, as is the SIEV. Notably, the DIEV is not identifiable. Figure 2A
Discussion
The current study has identified in-vivo evidence of a cutaneous shunt between the arterial perforators of the abdominal wall integument and the superficial venous drainage of the abdominal wall using CTA. This physiological phenomenon was present in all cases, and confirms the presence of a universal non-capillary AVA shunt. As all patients demonstrated evidence of this vascular shunt, it can be assumed that this phenomenon is not due to an abnormal arteriovenous fistula or other anomaly;
Conflict of interest
None. There are no financial and personal relationships with other people or organisations that could inappropriately influence (bias) this work.
Acknowledgements
Dr Damien Stella, Director of CT, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Ms Cara Michelle Le Roux, Research Fellow, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria, Australia.
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