USE OF MAGNETIC-RESONANCE ANGIOGRAPHY FOR THE PREOPERATIVE EVALUATIONOF PATIENTS WITH INFRAINGUINAL ARTERIAL OCCLUSIVE DISEASE

Purpose: This study was designed to determine whether magnetic resonan ce angiography (MRA) will allow preoperative management decisions with out the need for contrast arteriography in patients with lower extremi ty ischemia caused by infrainguinal arterial occlusive disease. Method s: Forty-five patients with lower extremity ischemia in 50 limbs were evaluated by both two-dimensional time-of-flight MRA and intraarterial digital subtraction angiography (DSA) between February 1992 and June 1995. Independent management plans were based on clinical presentation , pulse volume recordings, and separate reviews of the MRA and DSA. Re sults: Of 50 limbs, 23 required arterial bypass, 19 percutaneous trans luminal angioplasty, 5 patch angioplasty, and 3 amputation. MRA and DS A correlated exactly in 89.5% of infrainguinal arterial segments, wher eas interpretations disagreed in 10.5% of arterial segments. Mismatche s that had an influence on patient treatment decisions occurred in onl y 8 (2.3%) of 352 arterial segments. Independent MRA- and DSA-based re vascularization plans agreed in 45 (90%) extremities. MRA predicted th e revel of arterial reconstruction in all 23 limbs that required arter ial bypass. MRA identified focal stenoses amenable to percutaneous tra nsluminal angioplasty in 18 (94.7%) of the 19 limbs that ultimately un derwent percutaneous transluminal angioplasty. A strategy of preoperat ive planning by MRA with confirmatory intraoperative arteriography wou ld represent a 31% cost savings per patient at our institution while e liminating the morbidity of preoperative DSA. Conclusions: When used i n combination with the patient's physical examination and segmental li mb pressures with plethysmography MRA is sufficient for planning infra inguinal arterial bypass procedures and selecting patients for percuta neous transluminal angioplasty.