Hingorani Anil, Ascher Enrico, Markevich Natalia, Kallakuri Sreedhar, Hou Alex, Schutzer Richard, Yorkovich William
Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
J Vasc Surg. 2004 Apr;39(4):717-22. doi: 10.1016/j.jvs.2003.12.035.
In an effort to explore alternatives to contrast material-enhanced arteriography, we compared magnetic resonance angiography (MRA) and duplex arteriography (DA) with contrast arteriography (CA) for defining anatomic features in patients undergoing lower extremity revascularization.
From August 1, 2001, to August 1, 2002, 61 consecutive inpatients (64 limbs) with chronic lower extremity ischemia underwent CA, MRA, and DA before undergoing lower extremity revascularization procedures. The reports of these tests and images were compared prospectively, and the differences in the iliac, femoropopliteal, and infrapopliteal segments were noted. The vessels were classified as mildly diseased (<50%), moderately diseased (50%-70%), severely diseased (71%-99%), or occluded. The studies and treatment plans based on these data were compared.
Mean patient age was 76 +/- 10 years (SD). Indications for the procedures included gangrene (43%), ischemic ulcer (28%), rest pain (19%), severe claudication (9%), and failing bypass (1%). During this period 35 patients were ineligible for the protocol, because they could not undergo MRA (n=27) or angiography (n=8). Of the total 192 segments in the 64 patients (iliac, femoropopliteal, tibial), 17% were not able to be fully assessed with DA, and 7% with MRA. Disagreements with CA and DA were found in the iliac, femoropopliteal, and tibial segments in 0%, 7%, and 14% of cases, respectively, and between CA and MRA in 10%, 26%, and 42% of cases, respectively. Two of 9 differences (22%) between DA and CA were thought to be clinically significant, and 28 of 45 differences (62%) between MRA and CA were thought to be clinically significant.
A review of the data obtained in this series indicates that MRA does not yet seem to yield adequate data, at least in this highly selected population at our institution. When severe calcification is identified, CA may be necessary in patients undergoing DA.
为探索对比剂增强血管造影的替代方法，我们将磁共振血管造影（MRA）和双功动脉造影（DA）与对比血管造影（CA）进行比较，以明确接受下肢血管重建患者的解剖特征。
2001年8月1日至2002年8月1日，61例连续的慢性下肢缺血住院患者（64条肢体）在接受下肢血管重建手术前接受了CA、MRA和DA检查。对这些检查报告和图像进行前瞻性比较，记录髂动脉、股腘动脉和腘下动脉节段的差异。血管分为轻度病变（<50%）、中度病变（50%-70%）、重度病变（71%-99%）或闭塞。比较基于这些数据的研究和治疗方案。
患者平均年龄为76±10岁（标准差）。手术指征包括坏疽（43%）、缺血性溃疡（28%）、静息痛（19%）、严重跛行（9%）和搭桥失败（1%）。在此期间，35例患者不符合方案要求，因为他们无法接受MRA（n=27）或血管造影（n=8）。在64例患者的192个节段（髂动脉、股腘动脉、胫动脉）中，17%的节段无法通过DA进行全面评估，7%的节段无法通过MRA进行全面评估。CA与DA在髂动脉、股腘动脉和胫动脉节段的分歧分别为0%、7%和14%，CA与MRA在这些节段的分歧分别为10%、26%和42%。DA与CA之间的9处差异中有2处（22%）被认为具有临床意义，MRA与CA之间的45处差异中有28处（62%）被认为具有临床意义。
对本系列获得的数据进行回顾表明，至少在我们机构的这一高度选择的人群中，MRA似乎尚未产生足够的数据。当发现严重钙化时，接受DA检查的患者可能需要进行CA检查。
