title: Contrast-enhanced 3D MRA of the aortoiliac and infrainguinal arteries when conventional transfemoral arteriography is not feasible.
abstract: OBJECTIVE
  To evaluate whether contrast-enhanced 3-dimensional (3D) magnetic resonance angiography (MRA) can substitute for transaxillary or transbrachial catheter access when angiography via the transfemoral route is not possible.
  
  
  METHODS
  Contrast-enhanced 3D MRA was performed in 14 patients (12 men; mean 66.1 +/- 12.4 years, range 48-98) with atherosclerotic disease of the aorta or lower extremities in whom conventional transfemoral arteriography was not feasible. The images were evaluated for their ability to identify and characterize lesions directly responsible for the patient's symptoms, adequately depict the vascular anatomy for therapy planning, and identify additional lesions not directly responsible for the patient's symptoms. The arterial system was divided into 15 segments, and image quality and the presence of occlusive disease were determined.
  
  
  RESULTS
  MRA adequately depicted 387 (95%) of 406 arterial segments in 14 patients. Nineteen (5%) arterial segments were inadequately delineated because of low signal intensity distal from severe stenoses (n = 11), venous overlap (n = 6), or metallic clip-induced signal voids (n = 2). The lesions directly responsible for the patients' symptoms were identified in all 14 patients (2 aortic occlusions [Leriche's syndrome] and 12 iliac occlusions or severe stenoses). Visualization of the vascular anatomy was adequate for therapy planning in 13 of 14 patients, and 3D MRA satisfactorily identified other lesions not directly responsible for the current symptoms.
  
  
  CONCLUSIONS
  When transfemoral catheter angiography of the aortoiliac and lower extremities is not feasible, contrast-enhanced 3D MRA is suitable for determining and planning therapy and can be used instead of angiography via the transaxillary or transbrachial routes.
authors.affiliation: Department of Radiology, University of Ulm, Germany. sabinefenchel@aol.com
authors.forename: Sabine
authors.initials: S
authors.lastname: Fenchel
authors.forename: Christian
authors.initials: C
authors.lastname: Wisianowsky
authors.forename: Silvia
authors.initials: S
authors.lastname: Schams
authors.forename: Karin
authors.initials: K
authors.lastname: Nuessle
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Krämer
authors.forename: Johannes
authors.initials: J
authors.lastname: Görich
authors.forename: Elmar M
authors.initials: EM
authors.lastname: Merkle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001027:Aortography; D001158:Arteries; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D005260:Female; D006119:Groin / Q000098:blood supply; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D015641:Radiography, Interventional