Jr. Leyendecker et al., THE ROLE OF INFRAPOPLITEAL MR-ANGIOGRAPHY IN PATIENTS UNDERGOING OPTIMAL CONTRAST ANGIOGRAPHY FOR CHRONIC LIMB-THREATENING ISCHEMIA, Journal of vascular and interventional radiology, 9(4), 1998, pp. 545-551
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.