Rogers Jason H, Caruthers Shelton D, Williams Todd, Lin S J, Meyers Deborah, Lanza Gregory M, Kovacs Sandor, Lasala John M, Wickline Samuel A
Division of Cardiovascular Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
J Cardiovasc Magn Reson. 2004;6(1):25-31. doi: 10.1081/jcmr-120027802.
The presence of peripheral vascular disease, in particular iliofemoral disease, is responsible in part for vascular complications from femoral artery cannulation. We investigated whether prescreening for vascular obstructions with magnetic resonance angiography (MRA) in high-risk patients with peripheral vascular disease (PVD) would provide useful information to angiographers seeking to improve the safety and efficiency of femoral artery access at cardiac catheterization.
Twelve consecutive patients with known or suspected PVD underwent contrast-enhanced, aorto-iliofemoral MRA using a real-time BolusTrak technique. Contrast-to-noise ratios for each patient were calculated. The cardiac angiographer reviewed the MRA prior to catheterization and selected an access site. The patients' subsequent clinical course was evaluated, and a postprocedure questionnaire was completed by the angiographer to define the value of the prescreening MRA.
No significant vascular complications occurred in these patients as defined by failure of initially chosen access site, arterial dissection, limb ischemia, pseudoaneurysm formation, hemorrhage (including retroperitoneal hematoma), or need for blood transfusion or emergency vascular surgical repair. Statistical frequency analysis of the responses in the postprocedure questionnaire demonstrated that the MR data were clinically valuable in (1) influencing the initial choice of access site; (2) influencing technical alterations to the standard access; and, (3) enhancing confidence in the selection of access site.
MRA prescreening in patients with PVD is an effective, novel adjunct to cardiac catheterization in selected patients that improves physician confidence and influences technical choices during coronary angiography from the femoral artery approach.
外周血管疾病，尤其是髂股动脉疾病，是股动脉插管导致血管并发症的部分原因。我们研究了在高危外周血管疾病（PVD）患者中，使用磁共振血管造影（MRA）对血管阻塞进行预筛查，是否能为寻求提高心脏导管插入术时股动脉穿刺安全性和效率的血管造影师提供有用信息。
连续12例已知或疑似患有PVD的患者采用实时团注追踪技术接受了对比增强的腹主动脉-髂股动脉MRA检查。计算每位患者的对比噪声比。心脏血管造影师在导管插入术前查看MRA并选择穿刺部位。评估患者随后的临床病程，血管造影师完成术后问卷以确定预筛查MRA的价值。
按照最初选择的穿刺部位失败、动脉夹层、肢体缺血、假性动脉瘤形成、出血（包括腹膜后血肿）或输血或紧急血管外科修复需求来定义，这些患者未发生显著血管并发症。术后问卷回复的统计频率分析表明，MR数据在以下方面具有临床价值：（1）影响穿刺部位的初始选择；（2）影响对标准穿刺的技术调整；以及，（3）增强对穿刺部位选择的信心。
对PVD患者进行MRA预筛查是一种有效的新型辅助手段，可用于特定患者的心脏导管插入术，能提高医生信心并影响经股动脉途径进行冠状动脉造影时的技术选择。
