Patency of runoff detected by MR angiography at 3.0 T with cuff-compression: a predictor of successful endovascular recanalization below the knee.

Zhu, Yue-Qi; Zhao, Jun-Gong; Wang, Jue; Tan, Hua-Qiao; Lu, Hai-Tao; Liu, Fang; Cheng, Ying-Sheng; Wei, Li-Ming; Zhang, Pei-Lei

Objectives: Our aim was to assess the reliability of detecting distal runoff vessels using contrast-enhanced MR angiography (CE-MRA) that were occult on digital subtraction angiography (DSA) for predicting the outcome of endovascular recanalization (ER). Methods: This retrospective analysis comprised 63 patients with diabetes (98 limbs) who underwent ER for infrapopliteal lesions. Before ER, they underwent CE-MRA and DSA for peripheral arterial disease; runoff vessels were detected with CE-MRA, but not with DSA. Immediate and follow-up postoperative outcomes were assessed. Univariate analysis was performed to identify variables associated with successful ER. Results: Successful ER was achieved in 85.7 % of limbs, and runoff score was significantly lower than in failure limbs (5.1 ± 1.1 vs. 6.2 ± 1.3; P < 0.05). During follow-up, sustained ankle-brachial index (ABI) improvement was found in 76.6 % claudication patients, and walking distance improvement in 86.5 %; pain was relieved in 70.6 % of critical limb ischemia (CLI) limbs, ulceration healed in 81.3 %, and limb-salvage rate was 100 %. Restenosis/occlusion rate was higher for patients with CLI at 12 months (48.8 % vs. 96.3 % in claudication; P < 0.01). Runoff score was associated with a significantly higher likelihood of ER success (odds ratio = 4.096, 95 % confidence interval: 2.056-8.158; P < 0.001). Conclusion: Runoff vessels detected using CE-MRA could indicate immediate success and better outcome of ER for infrapopliteal occlusions. Key Points: • 3-T MRA with cuff compression displayed distal below-the-knee (BTK) runoffs better than DSA • Detected runoffs indicate high recanalization rate and good clinical outcome • Runoff display provides potential opportunity to perform other backup recanalization strategies

MAGNETIC resonance angiography; ARTERIES; ANGIOPLASTY; DIGITAL subtraction angiography; UNIVARIATE analysis

European Radiology, 2014, Vol 24, Issue 11, p2857

0938-7994

Academic Journal

10.1007/s00330-014-3314-7