Angiographic delay: a viable alternative to surgical delay

Since its description by Hartrampf et al in 1982, the transverse rectus abdominis musculocutaneous (TRAM) flap has been the most frequently used autologous flap procedure for breast reconstruction. To improve the vascularity of the pedicled TRAM flap, a preoperative delay procedure can be performed. Both surgical delay (ligation of both artery and vein) and delay by selective embolization of the inferior epigastric arteries have been described. Scheufler et al first introduced the concept of delay by selective embolization in 2000.

We reviewed a series of 88 consecutive endovascularly delayed unipedicled TRAM flap breast reconstructions by the senior author (N.B.). The purpose of this study was twofold: (1) to determine whether delay by selective arterial embolization is comparable to surgically delayed pedicled TRAM flaps as reported in the literature, in terms of skin and fat necrosis, and (2) to examine whether certain risk factors play a role in TRAM flap fat necrosis despite arterial angiographic delay.

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