Association of Cardiovascular Risk Factors with Atherosclerotic Changes in Lower-Limb Donor Arteries for Free Flap Reconstruction: A CTA-Based Multivariate Analysis.

Abstract Background: The selection and condition of donor vessels are critical for successful free flap reconstruction. Key lower-limb donor-pedicle arteries include the medial and lateral circumflex femoral (MCFA, LCFA), deep femoral (DFA), superficial inferior epigastric (SIEA), and superficial circumflex iliac (SCIA) arteries. This study evaluated atherosclerotic changes in these arteries and their associations with major cardiovascular risk factors using computed tomographic angiography (CTA). Methods: A retrospective CTA study assessed stenosis and plaque burden in five lower-limb arteries. Univariable and multivariable binary logistic GEE models evaluated factors associated with arterial stenosis. Results: A total of 113 patients (223 extremities; mean age 63.5 ± 15.4 years) were analyzed. Hypertension was the most consistent independent predictor of stenosis, remaining significantly associated with the MCFA, LCFA, DFA, and SIEA. LCFA stenosis was independently associated with age, hypertension, and diabetes mellitus. Severe atherosclerotic plaque burden was independently associated with the DFA, SIEA, and SCIA and was the only independent predictor of SCIA stenosis. The MCFA and SCIA had the highest proportions of vessels with grade 0 stenosis. . Conclusion: The study underscores the complex relationship between underlying diseases and arterial stenosis in microvascular reconstruction. Therefore, preoperative CTA evaluation is advised in patients with atherosclerotic risk to guide donor-vessel selection and improve personalized care and procedural success.