Prevalence of Accessory Branches and Other Anatomical Variations of the Radial Artery Encountered During Radial Forearm Flap Harvest: A Systematic Review and Meta-Analysis

Location

Medical Education Building, LSUHSC-NO

Presentation Date

10-10-2019 10:00 AM

End Date

10-10-2019 12:00 PM

Description

Background: Motivated by the intra-operative discovery of an anomalous branch of the radial artery during radial forearm flap (RFF) harvest, the purpose of this study was to systematically review the literature regarding anatomical abnormalities of the radial artery that can affect flap harvest and perform a meta-analysis to estimate the prevalence of such abnormalities.

Methods: A systematic review of the literature was conducted using five online databases to identify all instances of radial artery anatomical variations. Abstracts were reviewed and categorized into either 1) large cohort studies of anatomical variations identified by angiogram or 2) case reports specifically mentioning anomalous or accessory branches of the radial artery. Data from the large cohort studies were included in a meta-analysis to estimate the prevalence of such variations. Case reports were reviewed and summarized.

Results: Eighteen angiogram cohort studies containing a total of 18,115 patients were included in the meta-analysis. Accessory branches or double radial arteries were the most uncommon anatomical variant reported, with an estimated prevalence of 0.5%. Prevalence estimates for more common anatomical variants, including radial artery loops (0.9%), stenosis (1.5%), hypoplasia (1.9%), tortuosity (4.3%), and abnormal origin (5.6%) were also calculated. In total, radial artery abnormalities are estimated to occur with an average prevalence of 10.5%. Thirteen case reports detailing anomalous branches of the radial artery were reviewed, seven of which involved accessory branches encountered during radial forearm flap harvest with no incidence of flap loss.

Conclusions: Radial artery accessory branches are exceedingly rare, but the prevalence of anatomical variations that can affect harvest of the RFF warrant consideration. We recommend surgeons comprehensively screen prior to RFF harvest to avoid intra-operative discovery of anatomical variants and suggest a low threshold for repeat perfusion testing intra-operatively if radial artery accessory branches are encountered.

Comments

Mentor: Frank Lau (Department of Plastic and Reconstructive Surgery)

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Oct 10th, 10:00 AM Oct 10th, 12:00 PM

Prevalence of Accessory Branches and Other Anatomical Variations of the Radial Artery Encountered During Radial Forearm Flap Harvest: A Systematic Review and Meta-Analysis

Medical Education Building, LSUHSC-NO

Background: Motivated by the intra-operative discovery of an anomalous branch of the radial artery during radial forearm flap (RFF) harvest, the purpose of this study was to systematically review the literature regarding anatomical abnormalities of the radial artery that can affect flap harvest and perform a meta-analysis to estimate the prevalence of such abnormalities.

Methods: A systematic review of the literature was conducted using five online databases to identify all instances of radial artery anatomical variations. Abstracts were reviewed and categorized into either 1) large cohort studies of anatomical variations identified by angiogram or 2) case reports specifically mentioning anomalous or accessory branches of the radial artery. Data from the large cohort studies were included in a meta-analysis to estimate the prevalence of such variations. Case reports were reviewed and summarized.

Results: Eighteen angiogram cohort studies containing a total of 18,115 patients were included in the meta-analysis. Accessory branches or double radial arteries were the most uncommon anatomical variant reported, with an estimated prevalence of 0.5%. Prevalence estimates for more common anatomical variants, including radial artery loops (0.9%), stenosis (1.5%), hypoplasia (1.9%), tortuosity (4.3%), and abnormal origin (5.6%) were also calculated. In total, radial artery abnormalities are estimated to occur with an average prevalence of 10.5%. Thirteen case reports detailing anomalous branches of the radial artery were reviewed, seven of which involved accessory branches encountered during radial forearm flap harvest with no incidence of flap loss.

Conclusions: Radial artery accessory branches are exceedingly rare, but the prevalence of anatomical variations that can affect harvest of the RFF warrant consideration. We recommend surgeons comprehensively screen prior to RFF harvest to avoid intra-operative discovery of anatomical variants and suggest a low threshold for repeat perfusion testing intra-operatively if radial artery accessory branches are encountered.