Catheter embolization of the inferior epigastric artery - a minimal invasive method for TRAM-flap conditioning

The pedicled transverse rectus abdominis musculocutaneous (TRAM) flap is a recognized, reliable method of autogenous tissue breast reconstruction afte r mastectomy. However, the blood supply to the distal part of the flap is o ften precarious after ligation of the the main feeder, the inferior epi gas tric artery (AEI), at time of the operation. We describe our clinical exper ience with a new technique to augment the superior blood stream (superior e pigastric artery, AES) by selective embolization of the inferior epigastric artery some weeks prior to plastic surgery. One hundred and eleven emboliz ation procedures were performed until now. Technique of crossover and ipsil ateral epigastric spiral embolization is described, requiring minimal time and material as an in- or outpatient procedure. The anatomical situation of the m. rectus abdominis blood supply is discussed as well as possible comp lications of the procedure.