The role of infrapopliteal MR angiography in patients undergoing optimal contrast angiography for chronic limb-threatening ischemia.
OBJECTIVE
To determine the benefit of infrapopliteal magnetic resonance angiography (MRA) in patients with chronic limb-threatening ischemia who have undergone optimal contrast angiography (CA).


METHODS
Thirty-four patients (37 limbs) with limb-threatening chronic lower extremity ischemia underwent MRA and CA of the symptomatic extremity. Selective, vasodilator-enhanced digital subtraction angiography of the infrapopliteal vessels was possible for 34 limbs. Two vascular surgeons retrospectively formulated treatment plans based on CA. They then formulated treatment plans based on CA and MRA together.


RESULTS
CA 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 have improved clinical outcome in only one. The amount of inflow disease did not appear to influence segment visualization or treatment planning. In eight of 11 limbs that eventually required below- or above-knee amputation, CA clearly visualized more vascular segments than MRA. One patient developed renal insufficiency after CA.


CONCLUSIONS
Most patients undergoing optimal CA for chronic limb-threatening ischemia will not benefit from the addition of MRA. However, MRA should be considered when CA is suboptimal and when it is necessary to conserve contrast material.
Department of Radiology, Wilford Hall Medical Center, Lackland AFB, TX 78236, USA.
J R
JR
Leyendecker
K D
KD
Elsass
S P
SP
Johnson
D C
DC
Diffin
D L
DL
Cull
J T
JT
Light
D L
DL
Dawson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015901:Angiography, Digital Subtraction; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007485:Ioxaglic Acid; D007511:Ischemia / Q000175:diagnosis* / Q000601:surgery; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D003287:Contrast Media; D007485:Ioxaglic Acid