The role of magnetic resonance angiography for endoprosthetic design

Objectives: Many patients with aortic aneurysms have renal insufficiency an d may be at increased risk when conventional imaging modalities (contrast-e nhanced computed tomography and arteriography) are used for aortic endograf t design. Our objective was to determine if magnetic resonance angiography (MRA) could be used as the sole imaging modality for endoprosthetic design. Methods: A total of 96 consecutive patients who underwent endovascular repa ir of thoracic (5) and abdominal (91) aortic aneurysms (April 1998-December 1999) were included in this study. Data were collected prospectively Gadol inium-enhanced MRA was used preoperatively in place of conventional imaging if renal insufficiency or a history of severe contrast reaction was presen t. The control group underwent conventional imaging. Endografts used includ ed Ancure, AneuRx, and Talent. Results: Fourteen patients (14.6%) had their endografts designed solely wit h MRA. Intraoperative access failure; proximal and distal extensions (unpla nned); conversion to open, aborted procedures; and endoleaks occurred with equal frequency in both the MRA-designed and control groups (16.7% vs 18.3% , respectively; P = .33). Despite baseline renal insufficiency, there was n o significant rise in the creatinine level after endograft implantation in patients with an MRA design (preoperative level, 1.8; postoperative level, 1.9; P = .5). Conclusion: MRA may be successfully used as the sole modality for aortic en dograft design. The use of MRA for this purpose is noninvasive and minimize s nephrotoxic risk.