Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: A prospective study

R. P. Cambria, John Kaufman, G. J. L'Italien, J. P. Gertler, G. M. LaMuraglia, D. C. Brewster, S. Geller, S. Atamian, A. C. Waltman, W. M. Abbott

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Purpose: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. Methods: During the interval of September 1993 through March 1995, 79 patients (43% claudicants, 57% limb threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9%), surgical inflow (28%), or outflow (63%) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25% to 50%), moderate (51% to 75%), or severe (75% to 99%) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (χ-square). Results: Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85% of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. Conclusion: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.

Original languageEnglish (US)
Pages (from-to)380-389
Number of pages10
JournalJournal of Vascular Surgery
Volume25
Issue number2
DOIs
StatePublished - 1997
Externally publishedYes

Fingerprint

Arterial Occlusive Diseases
Magnetic Resonance Angiography
Lower Extremity
Prospective Studies
Foot
Pathologic Constriction
Thigh
Blood Vessels
Knee
Hemodynamics
Therapeutics
Balloon Angioplasty
Pelvis
Anatomy
Angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Magnetic resonance angiography in the management of lower extremity arterial occlusive disease : A prospective study. / Cambria, R. P.; Kaufman, John; L'Italien, G. J.; Gertler, J. P.; LaMuraglia, G. M.; Brewster, D. C.; Geller, S.; Atamian, S.; Waltman, A. C.; Abbott, W. M.

In: Journal of Vascular Surgery, Vol. 25, No. 2, 1997, p. 380-389.

Research output: Contribution to journalArticle

Cambria, RP, Kaufman, J, L'Italien, GJ, Gertler, JP, LaMuraglia, GM, Brewster, DC, Geller, S, Atamian, S, Waltman, AC & Abbott, WM 1997, 'Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: A prospective study', Journal of Vascular Surgery, vol. 25, no. 2, pp. 380-389. https://doi.org/10.1016/S0741-5214(97)70360-4
Cambria, R. P. ; Kaufman, John ; L'Italien, G. J. ; Gertler, J. P. ; LaMuraglia, G. M. ; Brewster, D. C. ; Geller, S. ; Atamian, S. ; Waltman, A. C. ; Abbott, W. M. / Magnetic resonance angiography in the management of lower extremity arterial occlusive disease : A prospective study. In: Journal of Vascular Surgery. 1997 ; Vol. 25, No. 2. pp. 380-389.
@article{3d6a6bb177bf4d34bc7d343b0a74ae4a,
title = "Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: A prospective study",
abstract = "Purpose: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. Methods: During the interval of September 1993 through March 1995, 79 patients (43{\%} claudicants, 57{\%} limb threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9{\%}), surgical inflow (28{\%}), or outflow (63{\%}) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25{\%} to 50{\%}), moderate (51{\%} to 75{\%}), or severe (75{\%} to 99{\%}) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (χ-square). Results: Precise agreement ({\%}) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85{\%} of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. Conclusion: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.",
author = "Cambria, {R. P.} and John Kaufman and L'Italien, {G. J.} and Gertler, {J. P.} and LaMuraglia, {G. M.} and Brewster, {D. C.} and S. Geller and S. Atamian and Waltman, {A. C.} and Abbott, {W. M.}",
year = "1997",
doi = "10.1016/S0741-5214(97)70360-4",
language = "English (US)",
volume = "25",
pages = "380--389",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Magnetic resonance angiography in the management of lower extremity arterial occlusive disease

T2 - A prospective study

AU - Cambria, R. P.

AU - Kaufman, John

AU - L'Italien, G. J.

AU - Gertler, J. P.

AU - LaMuraglia, G. M.

AU - Brewster, D. C.

AU - Geller, S.

AU - Atamian, S.

AU - Waltman, A. C.

AU - Abbott, W. M.

PY - 1997

Y1 - 1997

N2 - Purpose: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. Methods: During the interval of September 1993 through March 1995, 79 patients (43% claudicants, 57% limb threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9%), surgical inflow (28%), or outflow (63%) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25% to 50%), moderate (51% to 75%), or severe (75% to 99%) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (χ-square). Results: Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85% of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. Conclusion: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.

AB - Purpose: We conducted a prospective study to clarify the clinical utility of magnetic resonance angiography (MRA) in the treatment of patients with lower extremity arterial occlusive disease. Methods: During the interval of September 1993 through March 1995, 79 patients (43% claudicants, 57% limb threatening ischemia) were studied with both MRA and contrast arteriography (ANGIO) and underwent intervention with either balloon angioplasty (9%), surgical inflow (28%), or outflow (63%) procedures. MRA and ANGIO were interpreted by separate blinded vascular radiologists, and arterial segments from the pelvis to the foot were graded as normal or with increasing degrees of mild (25% to 50%), moderate (51% to 75%), or severe (75% to 99%) stenosis or occlusion. Treatment plans were formulated by the attending surgeon and were based initially on hemodynamic, clinical, and MRA data and thereafter with ANGIO. Additional study surgeons formulated independent and specific treatment plans based on MRA or ANGIO alone. Indexes of agreement (beyond chance) for arterial segments depicted by MRA and ANGIO were assessed (kappa value), and treatment plans formulated were compared (χ-square). Results: Precise agreement (%) and the percent of major discrepancies (segment classified as normal/mild stenosis on one study and severe stenosis/occlusion on the other) between MRA and ANGIO for respective arterial segments was as follows: common and external iliacs (n = 256) 77/3.5; superficial femoral and above-knee popliteal (n = 255) 73/6.7; below-knee popliteal (n = 131) 84/3.8; infrapopliteal runoff vessels (n = 864) 74/12.4; pedal vessels (n = 111) 69/19.8 Kappa values indicated moderate agreement (between MRA and ANGIO) beyond chance for all arterial segments. Treatment plans formulated by the attending surgeon, the MRA surgeon, and the ANGIO surgeon agreed in more than 85% of cases. Inability of MRA to assess the significance of inflow disease and inadequate detail of tibial/pedal vessels were the principal deficiencies of MRA in those cases where it was considered an inadequate examination. Conclusion: These findings suggest MRA and ANGIO are nearly equivalent examinations in the demonstration of infrainguinal vascular anatomy. MRA is an adequate preoperative imaging study (and may replace ANGIO), particularly in those circumstances when the risk of ANGIO is increased or when clinical and hemodynamic evaluation predict the likelihood of straightforward aortofemoral or femoral-popliteal reconstruction.

UR - http://www.scopus.com/inward/record.url?scp=0031047848&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031047848&partnerID=8YFLogxK

U2 - 10.1016/S0741-5214(97)70360-4

DO - 10.1016/S0741-5214(97)70360-4

M3 - Article

C2 - 9052573

AN - SCOPUS:0031047848

VL - 25

SP - 380

EP - 389

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 2

ER -