Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis

Alexander K Bartella; Carolin Luderich; Mohammad Kamal; Till Braunschweig; Julius Steegmann; Ali Modabber; Anita Kloss-Brandstätter; Frank Hölzle; Bernd Lethaus

doi:10.1016/j.joms.2020.01.019

Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis

J Oral Maxillofac Surg. 2020 Jun;78(6):1020-1026. doi: 10.1016/j.joms.2020.01.019. Epub 2020 Jan 27.

Authors

Alexander K Bartella¹, Carolin Luderich², Mohammad Kamal³, Till Braunschweig⁴, Julius Steegmann², Ali Modabber⁵, Anita Kloss-Brandstätter⁶, Frank Hölzle⁷, Bernd Lethaus⁸

Affiliations

¹ Resident, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany; and Resident, Department of Maxillofacial Surgery, Leipzig University, Leipzig, Germany. Electronic address: alexander.bartella@medizin.uni-leipzig.de.
² Resident, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany.
³ Assistant Professor, Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait.
⁴ Consultant, Department of Pathology, RWTH Aachen University, Aachen, Germany.
⁵ Consultant, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany.
⁶ Assistant Professor, Department of Engineering & IT, Carinthia University of Applied Sciences, Villach, Austria.
⁷ Head, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany.
⁸ Head, Department of Maxillofacial Surgery, Leipzig University, Leipzig, Germany.

PMID: 32087118
DOI: 10.1016/j.joms.2020.01.019

Abstract

Purpose: In reconstructive microsurgery, severe arteriosclerosis is a known predictor for free flap failure because of problems with the vascular anastomosis. We investigated whether the ankle brachial index (ABI) could be a suitable preoperative measurement for the prediction of compromise regarding vascular anastomosis in patients undergoing microsurgical reconstruction.

Material and methods: We conducted a prospective cohort study of patients who had undergone reconstructive microvascular surgery in a tertiary care center from 2015 to 2017. The ABI was preoperatively assessed by dividing the systolic blood pressure measured at the ankle by the brachial systolic blood pressure. Results from 0.9 to 1.3 are within the physiologic range. Values less than 0.9 indicate moderate to severe arteriosclerosis, and those greater than 1.3 indicate the major form of arteriosclerosis with complete calcification of the tunica media. The ABI value correlated with the ease of the anastomosis (rated from 1 [very straightforward] through 5 [very difficult]), gross examination findings (intraluminal plaque [yes vs no]), and the necessity of plaque removal before anastomosis (yes vs no). In addition, cross-sectional specimens were obtained from the arteries and veins of the donor and recipient sites intraoperatively. The specimens were rated histologically for the arteries and veins using an ordinal scale. Histologic evaluation was performed to confirm and objectify the results from the ABI. Statistical analysis was performed using SPSS software, version 24.0 (IBM Corp, Armonk, NY) and t tests, analysis of variance, and χ² tests.

Results: The sample included 41 patients with a mean age of 56.7 years; 59% were men. The mean ABI was 1.06. The mean ease of anastomosis was 1.8. The mean ABI was associated with the ease of anastomosis. A pathologic ABI was significantly related to problems with the arterial anastomosis (P = .004) and increased arteriosclerosis in the arteries from the donor (P = .047) and recipient (P = .036) sites.

Conclusions: A pathologic ABI was associated with increased difficulty with the microvascular anastomosis.

MeSH terms

Anastomosis, Surgical
Ankle Brachial Index*
Blood Pressure
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies