From the Guidelines
The repair of the inferior epigastric artery should be guided by preoperative imaging, preferably using CTA of the abdomen and pelvis with IV contrast, to accurately identify and measure the perforator branches, as recommended by the most recent guidelines 1. This approach is crucial for surgical planning, especially in procedures like breast reconstruction surgery, where the deep inferior epigastric artery plays a significant role. The use of CTA allows for detailed visualization of the vascular anatomy, which can help in reducing complications and improving outcomes by enabling the surgical team to prioritize the best vessel to use 1.
When it comes to the actual repair, the method depends on the nature and extent of the injury. For instance:
- In cases of active bleeding, immediate surgical exploration with direct vessel ligation or primary repair using fine non-absorbable sutures is necessary.
- For pseudoaneurysm formation, options include ultrasound-guided compression, ultrasound-guided thrombin injection, or endovascular embolization.
- Larger defects may require vascular grafting.
Post-procedure care is also critical, including close hemodynamic monitoring, serial hemoglobin checks, and possibly imaging to confirm successful repair. The inferior epigastric artery's anatomical position makes it vulnerable during certain abdominal wall procedures, and prompt recognition and treatment of injuries are essential to prevent significant complications like retroperitoneal hemorrhage or rectus sheath hematoma.
It's worth noting that while other evidence may discuss the use of the inferior epigastric artery in different contexts, such as coronary artery bypass graft surgery 1, the most recent and relevant guidelines for its repair, especially in the context of surgical planning for procedures like breast reconstruction, emphasize the importance of preoperative imaging with CTA 1.
From the Research
Repair of Inferior Epigastric Artery
To repair an inferior epigastric artery, several methods can be employed, including:
- Embolization of the inferior epigastric artery, which has been shown to be effective in achieving hemostasis after vascular trauma 2, 3
- Percutaneous selective angiography followed by embolization with platinum microcoils and polyvinyl alcohol, as described in a case report 2
- Transcatheter arterial embolization (TAE) using a coaxial catheter technique with a 0.018-inch microcatheter, which has been reported to have a high technical success rate 3
- Conservative management, including the use of colour Doppler ultrasound and arteriography embolisation, which can be effective in managing arteriovenous fistula of the inferior epigastric artery 4
Prevention of Injury
Prevention of injury to the inferior epigastric artery is also crucial, and can be achieved by:
- Raising awareness of the anatomical variations of the course of the inferior epigastric artery in relation to abdominal landmarks 5
- Defining a safer zone for laparoscopic ancillary trocar placement 5
- Using techniques to minimize the risk of injury to the inferior epigastric artery, such as careful placement of intra-abdominal drains and Tenckhoff catheters 5
Management of Complications
In cases where injury to the inferior epigastric artery does occur, management of complications is critical, and may involve: