THE ROLE OF INFRAPOPLITEAL MR-ANGIOGRAPHY IN PATIENTS UNDERGOING OPTIMAL CONTRAST ANGIOGRAPHY FOR CHRONIC LIMB-THREATENING ISCHEMIA

PURPOSE: To determine the benefit of infrapopliteal magnetic resonance angiography (MRA) in patients with chronic limb-threatening ischemia who have undergone optimal contrast angiography (CA), PATIENTS AND MET HODS: Thirty-four patients (37 limbs) with limb-threatening chronic lo wer extremity ischemia underwent MRA and CA of the symptomatic extremi ty. Selective, vasodilator-enhanced digital subtraction angiography of the infrapopliteal vessels was possible for 34 limbs. Two vascular su rgeons retrospectively formulated treatment plans based on CA. They th en formulated treatment plans based on CA and MRA together. RESULTS: C A clearly visualized 495 of 888 vascular segments as patent, while MRA clearly visualized 412 of 888 segments. Treatment plans differed for at least one of two surgeons in eight limbs, but MRA would possibly ha ve improved clinical outcome in only one. The amount of inflow disease did not appear to influence segment visualization or treatment planni ng. In eight of 11 limbs that eventually required below- or above-knee amputation, CA clearly visualized more vascular segments than MRA, On e patient developed renal insufficiency after CA. CONCLUSION: Most pat ients undergoing optimal CA for chronic limb-threatening ischemia will not benefit from the addition of MRA, However, MRA should be consider ed when CA is suboptimal and when it is necessary to conserve contrast material.