Computed tomography angiography in microsurgery: indications, clinical utility, and pitfalls.


OBJECTIVE: Computed tomographic angiography (CTA) can be used to obtain 3-dimensional vascular images and soft-tissue definition. The goal of this study was to evaluate the reliability, usefulness, and pitfalls of CTA in preoperative planning of microvascular reconstructive surgery. METHODS: A retrospective review of patients who obtained preoperative CTA in preparation for planned microvascular reconstruction was performed over a 5-year period (2001-2005). The influence of CTA on the original operative plan was assessed for each patient, and CTA results were correlated to the operative findings. RESULTS: Computed tomographic angiography was performed on 94 patients in preparation for microvascular reconstruction. In 48 patients (51%), vascular abnormalities were noted on CTA. Intraoperative findings correlated with CTA results in 97% of cases. In 42 patients (45%), abnormal CTA findings influenced the original operative plan, such as the choice of vessels, side of harvest, or nature of the reconstruction (local flap instead of free tissue transfer). Technical difficulties in performing CTA were encountered in 5 patients (5%) in whom interference from external fixation devices was the main cause. CONCLUSIONS: This large study of CTA obtained for preoperative planning of reconstructive microsurgery at both donor and recipient sites study demonstrates that CTA is safe and highly accurate. Computed tomographic angiography can alter the surgeon's reconstructive plan when abnormalities are noted preoperatively and consequently improve results by decreasing vascular complication rates. The use of CTA should be considered for cases of microsurgical reconstruction where the vascular anatomy may be questionable.








Geoffrey D Rubin

Adjunct Professor in the Department of Radiology

Geoffrey D. Rubin, MD, MBA, FACR, FAHA, FSABI, FNASCI is the George B. Geller Distinguished Professor for Research in Cardiovascular Diseases and Professor of Radiology at Duke University.

Born in Los Angeles, California, he earned Bachelor of Science degrees with Honor in Chemistry and Biology from the California Institute of Technology in 1982 and MD degree from the University of California, San Diego in 1987. He spent the next 22 years at Stanford University where he completed Diagnostic Radiology residency in 1992, a Body Imaging fellowship in 1993, and after joining the faculty in 1993 earned the rank of full Professor with university tenure in 2005.

Beginning in 1991, Dr. Rubin and colleagues at Stanford pioneered the development and use of spiral and multidetector-row CT for imaging the cardiovascular system. He is the lead author on the earliest scientific reports of CT angiography applied to a breadth of thoracic, abdominal, and peripheral vascular applications. Dr. Rubin founded and became Chief of Cardiovascular Imaging in 2000 where he fostered collaborative cross-disciplinary teams that facilitated a transformation from invasive to non-invasive CT-based diagnosis and treatment planning for many vascular disorders, notably the application of stent-grafts for aortic aneurysms.

Dr. Rubin co-founded the Stanford 3-D Medical Imaging Laboratory in 1996 and served as its Medical Director until 2010. His teams published the first descriptions of novel volumetric image presentations including perspective volume rendering as a basis for virtual endoscopy and curved planar reformations for blood vessel tracking and quantitation. The Stanford 3-D Laboratory established the first scalable clinical service facility for applying computer graphics and vision tools to medical imaging data, training hundreds of physicians and technologists to emulate the model worldwide.

Between 2005-2010, Dr. Rubin served as Associate Dean for Clinical Affairs in the School of Medicine, Associate Director of the Stanford Cardiovascular Institute from 2007-2010, and became the first Chief of Staff-Elect by the medical staff of Stanford Hospital & Clinics and serving as Vice Chief of Staff from 2007-2010. Through these leadership roles, he contributed to the establishment of Stanford’s first comprehensive electronic health record system, the management of a newly centralized School of Medicine faculty funds flow, transition to a self-governing medical staff organization, cross-departmental harmonization of clinical privileges, and policies formalizing the introduction of clinical innovations and management of conflicts of interest.

In 2010, Dr. Rubin assumed the role of Chairman of the Department of Radiology at Duke University where during his tenure he led the development and expansion of imaging services into new clinical and research facilities, increased diversity amongst departmental faculty and leadership, established a basis for an enterprise-wide imaging operation and infrastructure, and implemented an award-winning cross-disciplinary revenue integrity program.

His current work focuses on applications of artificial intelligence toward assisted interpretation of volumetric medical imaging, the contributions of perceptual variations to radiologist performance in volumetric image interpretation, and effective leadership and management in radiology and healthcare. In support of the latter focus, he is an avid mentor for radiology leaders and has developed and taught several national leadership training programs for the Radiology Leadership Institute of the American College of Radiology, where he has served as a founding Board Member since 2012.  Dr. Rubin is also President and Board Chair of the International Society for Computed Tomography, Board Member of RAD-AID International, and is co-chair of the RSNA-ACR Public Information Website Committee overseeing

Dr. Rubin is Past President of the North American Society for Cardiovascular Imagers, the Society for Computed Body Tomography and Magnetic Resonance, and the Fleischner Society for Thoracic Imaging and Diagnosis. He is the author of over 200 peer-reviewed manuscripts and over 50 review articles and book chapters. He has edited five books, including the highly acclaimed textbook, CT and MR Angiography: Comprehensive Vascular Assessment. He holds six U.S. patents on medical image analysis and has served as Principal Investigator of three NIH RO1s focused on imaging and analysis of cardiovascular and pulmonary diseases, “Measurement of the Aorta and its Branches” (1998-2003), “Efficient Interpretation of 3D Vascular Image Data” (2001-2007) and “Improving Radiologist Detection of Lung Nodules with CAD” (2004-2011). In 2008, he was awarded the “Most Effective Radiology Educator” by He is an active public speaker, having made over 1000 presentations to medical, scientific, and lay audiences in over 40 countries.

In 1997, he co-founded Trivascular Inc, remaining actively engaged in support of its development of low-profile aortic stent-grafts until the company was bought in 2004. In 2011, he co-founded Informatics in Context, providing real-time automated adjudication of prior authorization requests via EDI 278. Over the last 21 years, Dr. Rubin has served as a consultant to numerous start-ups seeking to bring important innovations to the marketplace.

In 2014 Dr. Rubin received an MBA from the Fuqua School of Business at Duke University, was named a Fuqua Scholar, and elected commencement speaker. He remains actively engaged with the Fuqua Health Sector Advisory Council and as a mentor to MBA students and recent graduates.

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