Magnetic resonance angiography unmasks reliable target vessels for pedal bypass grafting in patients with diabetes mellitus

Objective: The purpose of this study was to evaluate the performance of pedal bypass grafts to foot vessels detected by magnetic resonance angiography (MRA) that were occult in conventional angiography in patients with diabetes mellitus and severe arterial occlusive disease. Methods. Vascular surgery and radiology registries were reviewed for patients with pedal bypass grafts to arteries that were not detected with digital subtraction angiography but unmasked with MRA. From December 1997 to March 1999, 15 patients (mean age, 73 +/- 8 years) were identified and analyzed retrospectively. All the patients were diabetic, with 60% being insulin-dependent. Advanced tissue loss was the operative indication in all the cases. Distal anastomosis was performed to the dorsalis pedis artery in 10 cases and to the plantar artery in five cases, with ipsilateral greater saphenous vein as graft material in all the cases. Results: The perioperative mortality rate was 7% (1 of 15 cases). One graft occlusion resulted in a secondary patency rate of 93.1%. During a mean follow-up examination period of 22 months, no graft occlusions and one major amputation were noted, which resulted in a secondary patency rate of 93.1% and a limb salvage rate of 89.5% at 36 months. Conclusion: Foot vessels that were occult in conventional angiography but could be detected with MRA were shown to be suitable target vessels for pedal bypass grafting with promising results.