Abstract

Background

The gastro-omental artery (GOA) and the greater omentum are nowadays commonly used in many reconstructive surgeries, including cardiac, vascular, and plastic surgery. There are cases in which the GOA is found to be unsuitable only after partial harvesting following an upper laparotomy, and an improved method of pre-operative evaluation is required to eliminate the need for intraoperative small laparotomy.

Methods

Multidetector computed tomography was performed for 30 consecutive patients admitted for lower limb ischemia in a routine pre-operative evaluation of lower limb peripheral arterial disease (PAD). The origin of the GOA was checked on coronal and sagittal slices, its pathway was identified on the three-dimensional rendering. We assessed length and mean diameter of the distal and proximal right GOA, and the mean distances between the origins of GOA and the omental branches. Finally, we report one case of omental flow-through flap.

Results

30 patients were included in our study. Routine pre-operative MDCT during lower limb PAD workup enabled identification of GOA in all cases. The mean internal diameter of the GOA at its origin was 3.3 mm (± 3.3). The mean internal diameter of the distal GOA was 1.26 mm (± 0.3). At least one omental descending branch was detected in every case and in 63% (19 patients) at least two branches were visualized.

Conclusion

Routine pre-operative angio-MDCT imaging is an effective tool to assess precisely the different anatomical properties of the GOA. This exam could be useful for both diagnosis of lower limb PAD and evaluation of the GOA suitability for flow-through flap lower limb revascularisation.

中文翻译：

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大网膜游离皮瓣和流通皮瓣：右胃网膜动脉多检测器计算机断层扫描的术前评估。

摘要

背景

胃网膜动脉 (GOA) 和大网膜如今常用于许多重建手术，包括心脏、血管和整形手术。在某些情况下，仅在上剖腹手术后部分收获后才发现 GOA 不合适，因此需要改进术前评估方法以消除术中小剖腹手术的需要。

方法

在对下肢外周动脉疾病 (PAD) 的常规术前评估中，对 30 名因下肢缺血入院的连续患者进行了多排计算机断层扫描。在冠状和矢状切片上检查GOA的起源，在三维渲染上识别其通路。我们评估了远端和近端右侧 GOA 的长度和平均直径，以及 GOA 起点和网膜分支之间的平均距离。最后，我们报告了 1 例大网膜流通瓣。

结果

我们的研究包括 30 名患者。下肢 PAD 检查期间的常规术前 MDCT 能够在所有情况下识别 GOA。GOA 原点的平均内径为 3.3 毫米 (± 3.3)。远端 GOA 的平均内径为 1.26 毫米 (± 0.3)。在每个病例中至少检测到一个网膜降支，并且在 63%（19 名患者）中至少有两个分支被可视化。

结论

常规术前血管 MDCT 成像是精确评估 GOA 不同解剖特性的有效工具。该检查可用于下肢 PAD 的诊断和 GOA 对流通皮瓣下肢血运重建的适用性的评估。