A comparison of magnetic resonance angiography, contrast arteriography, and duplex arteriography for patients undergoing lower extremity revascularization

The objective of this study was to compare magnetic resonance angiography (MRA), contrast arteriography (CA), and duplex arteriography (DA) for defining anatomic features relevant to performing lower extremity revascularizations. From March 1, 2001 to August 1, 2001, 33 consecutive inpatients with chronic lower extremity ischemia underwent CA, MRA, and DA before undergoing lower extremity revascularization procedures. The reports of these tests were compared prospectively and the differences in the aortoiliac segment, femoral-popliteal, and infrapopliteal segments were noted. The vessels were classified as mild disease (<50%), moderate disease (50-70%), severe disease (71-99%), and occluded. These studies and treatment plans based on these data were compared. During this time period, 11 patients were not able to undergo MRA and therefore were excluded from the study. Thirty-three patients were included in this study. These patients underwent 35 procedures, as 2 patients underwent bilateral procedures. The mean age of the 33 patients was 76 +/- 10 years (SD). Indications for the procedures included gangrene (20), ischemic ulcer (8), rest pain (4), and severe claudication (1). Patients' medical history included diabetes mellitus (25), hypertension (20), and end-stage renal disease (5). No differences were noted between intraoperative findings and CA in this series. Two of the three differences between DA and CA were felt to be clinically significant whereas 9 of the 12 differences between MRA and CA were felt to be clinically significant. On the basis of these data in this series, MRA does not yet seem to be able to obtain adequate data on infrapopliteal segments, at least not for this highly selected population. When severe tibial calcification or very low flow states are identified, CA may be necessary for patients undergoing DA.