Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast- enhanced 3D MRA Stephan Langer, MD, Nils Krämer, MD, Gottfried.

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Presentation transcript:

Unmasking pedal arteries in patients with critical ischemia using time-resolved contrast- enhanced 3D MRA Stephan Langer, MD, Nils Krämer, MD, Gottfried Mommertz, MD, Thomas A. Koeppel, MD, Michael J. Jacobs, MD, Noor A. Wazirie, Christina Ocklenburg, MSC, Elmar Spüntrup, MD Journal of Vascular Surgery Volume 49, Issue 5, Pages 1196-1202 (May 2009) DOI: 10.1016/j.jvs.2008.12.025 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Selective digital subtraction angiography (DSA) (a-c) and maximum intensity projection magnetic resonance angiography (MRA) (d) of a 66-year-old female diabetic patient, suffering from chronic limb ischemia (CLI III5). DSA images show complex infrapopliteal occlusion disease and missing contrast agent in the distal calf and foot despite sufficient fluoroscopy examination time which resulted in slight motion artefacts of the foot DSA (grey arrow). Corresponding time-resolved three-dimensional magnetic resonance angiography (t3D MRA) depicted the patent distal anterior and distal posterior tibial artery as well as the dorsal pedal (white arrow) and medial plantar artery. Journal of Vascular Surgery 2009 49, 1196-1202DOI: (10.1016/j.jvs.2008.12.025) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Maximum intensity projections after background subtraction of a 69-year-old diabetic male with minor tissue loss of the heel chronic limb ischemia (CLI III5). Obvious here are the dynamic effect (3.9 seconds for each scan) with early contrast of the distal anterior and posterior tibial artery as well as clear imaging of pedal run-off with complete filling of the pedal arch. Thereafter, an impressive venous overlap can be seen. Journal of Vascular Surgery 2009 49, 1196-1202DOI: (10.1016/j.jvs.2008.12.025) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Magnetic resonance angiography (MRA) of a 51-year-old male insulin-dependent diabetic patient with a chronic heel ulcer chronic limb ischemia (CLI III5) due to an extensive segmental below knee occlusion of all crural arteries. Images demonstrate pedal vasculature before (left) and after pedal bypass grafting (right) prior to plastic surgery. Note the soft tissue enhancement at the site of the non-healing heel ulcer. The arterial reconstruction included a grafting of the posterior tibial artery. Due to inadequate intraoperative volume flow of 12 mL/minute, a jump graft to the dorsal pedal artery was indicated. Thereafter the vein graft flow was 26 mL/minute. Journal of Vascular Surgery 2009 49, 1196-1202DOI: (10.1016/j.jvs.2008.12.025) Copyright © 2009 Society for Vascular Surgery Terms and Conditions