PERIPHERAL VASCULAR-SURGERY WITH MAGNETIC-RESONANCE ANGIOGRAPHY AS THE SOLE PREOPERATIVE IMAGING MODALITY

Purpose: Magnetic resonance angiography (MRA) is a developing technique that provides arteriograms without the risks associated with iodinated contrast and arterial puncture or the expense of hospitalization. prior reports have demonstrated the accuracy of peripheral vessel MRA for evaluation of the aorta through pedal vessels. This study sought to determine whether vascular reconstructions could be planned and accomplished on the basis of MRA alone. Methods: Eighty consecutive candidates for bypass with ischemic rest pain or tissue loss were studied with preoperative outpatient MRA of the juxtarenal aorta through the foot. Confirmation of MRA findings was provided by intraoperative intraarterial pressure measurements for proximal vessels and postbypass arteriography for the runoff. Life-table analysis of graft patency and limb salvage was performed. Results: Two patients could not tolerate MRA and required contrast arteriography, but all others underwent reconstructive procedures on the basis of MRA alone (11 aortobifemoral, 67 infrainguinal). Intraoperative findings regarding suitability of inflow and outflow vessels confirmed the accuracy of the MRAs in every case. MRA indicated that none of the patients undergoing infrainguinal bypass had significant inflow occlusive disease, and this was confirmed at operation with pressure measurements of inflow vessels that were always within 10 mm Hg (peak systolic) of systemic pressure. The results of intraoperative completion arteriography and preoperative MRAs were identical for ah but two patients who had minor discrepancies. All aortobifemoral reconstructions remained patent, and all limbs remained intact. The infrainguinal reconstructions had an 84% limb salvage rate and 78% primary graft patency rate at 21 months. Comparison of charges for patients undergoing preoperative MRA versus contrast angiography showed a cost savings of $1288 for each patient treated with preoperative MRA alone. Conclusions: MRA is a noninvasive, cost-effective outpatient imaging technique that, if properly performed and interpreted, is sufficient for planning peripheral bypass procedures. Its use may supplant contrast arteriography in many patients.