Use of magnetic resonance angiography for the preoperative evaluation of patients with infrainguinal arterial occlusive disease John R. Hoch, MD, Michael.

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Presentation transcript:

Use of magnetic resonance angiography for the preoperative evaluation of patients with infrainguinal arterial occlusive disease John R. Hoch, MD, Michael J. Tullis, MD, Todd W. Kennell, MD, John McDermott, MD, Charles W. Acher, MD, William D. Turnipseed, MD Journal of Vascular Surgery Volume 23, Issue 5, Pages 792-801 (May 1996) DOI: 10.1016/S0741-5214(96)70241-0 Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 DSA of lower leg failed to identify artery suitable for bypass (A) in this diabetic patient with threatened limb. MRA demonstrated patent distal anterior tibial and dorsalis pedis arteries (B). Intraoperative angiography confirmed preoperative MRA findings (C). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 DSA of lower leg failed to identify artery suitable for bypass (A) in this diabetic patient with threatened limb. MRA demonstrated patent distal anterior tibial and dorsalis pedis arteries (B). Intraoperative angiography confirmed preoperative MRA findings (C). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 DSA of lower leg failed to identify artery suitable for bypass (A) in this diabetic patient with threatened limb. MRA demonstrated patent distal anterior tibial and dorsalis pedis arteries (B). Intraoperative angiography confirmed preoperative MRA findings (C). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Corresponding MRA (A, B, and E) and DSA (C and D) images of patient with diabetes and gangrenous toe who underwent left popliteal-posterior tibial bypass and superficial femoral patch angioplasty. MRA (A, arrow) identified focal superficial femoral artery origin stenosis seen on DSA (C, arrow). Patent posterior tibial artery seen on MRA (B, small arrows) was misidentified as peroneal on DSA (D, small arrow). Diffusely diseased tibioperoneal trunk was identified by both studies (B and D, large arrows). MRA axial images (E) confirmed tibial artery as posterior tibial (arrow), medial to tibia (T) and fibula (f). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Corresponding MRA (A, B, and E) and DSA (C and D) images of patient with diabetes and gangrenous toe who underwent left popliteal-posterior tibial bypass and superficial femoral patch angioplasty. MRA (A, arrow) identified focal superficial femoral artery origin stenosis seen on DSA (C, arrow). Patent posterior tibial artery seen on MRA (B, small arrows) was misidentified as peroneal on DSA (D, small arrow). Diffusely diseased tibioperoneal trunk was identified by both studies (B and D, large arrows). MRA axial images (E) confirmed tibial artery as posterior tibial (arrow), medial to tibia (T) and fibula (f). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Corresponding MRA (A, B, and E) and DSA (C and D) images of patient with diabetes and gangrenous toe who underwent left popliteal-posterior tibial bypass and superficial femoral patch angioplasty. MRA (A, arrow) identified focal superficial femoral artery origin stenosis seen on DSA (C, arrow). Patent posterior tibial artery seen on MRA (B, small arrows) was misidentified as peroneal on DSA (D, small arrow). Diffusely diseased tibioperoneal trunk was identified by both studies (B and D, large arrows). MRA axial images (E) confirmed tibial artery as posterior tibial (arrow), medial to tibia (T) and fibula (f). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Corresponding MRA (A, B, and E) and DSA (C and D) images of patient with diabetes and gangrenous toe who underwent left popliteal-posterior tibial bypass and superficial femoral patch angioplasty. MRA (A, arrow) identified focal superficial femoral artery origin stenosis seen on DSA (C, arrow). Patent posterior tibial artery seen on MRA (B, small arrows) was misidentified as peroneal on DSA (D, small arrow). Diffusely diseased tibioperoneal trunk was identified by both studies (B and D, large arrows). MRA axial images (E) confirmed tibial artery as posterior tibial (arrow), medial to tibia (T) and fibula (f). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Corresponding MRA (A, B, and E) and DSA (C and D) images of patient with diabetes and gangrenous toe who underwent left popliteal-posterior tibial bypass and superficial femoral patch angioplasty. MRA (A, arrow) identified focal superficial femoral artery origin stenosis seen on DSA (C, arrow). Patent posterior tibial artery seen on MRA (B, small arrows) was misidentified as peroneal on DSA (D, small arrow). Diffusely diseased tibioperoneal trunk was identified by both studies (B and D, large arrows). MRA axial images (E) confirmed tibial artery as posterior tibial (arrow), medial to tibia (T) and fibula (f). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Corresponding MRA (A, B, C, D) and DSA (E, F, G, H) images of patient with failing femoropoliteal graft. MRA failed to predict appropriate management plan, because critical stenosis near proximal anastomosis seen on DSA (E, straight arrow) was interpreted on MRA as signal dropout caused by surgical clips (A, straight arrow). Distal graft stenosis was correctly identified by both MRA (C, curved arrow) and DSA (G, curved arrow). Journal of Vascular Surgery 1996 23, 792-801DOI: (10.1016/S0741-5214(96)70241-0) Copyright © 1996 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions