Jungong Zhao MD, Presenter: Nothing to Disclose

To assess the reliability of distal runoff vessels detected using contrast-enhanced MR angiography (CE-MRA) but were occult on digital subtraction angiography (DSA) for predicting the outcome of endovascular recanalization (ER).

This retrospective analysis included 63 diabetes patients (98 limbs) who underwent ER for below-the-knee infrapopliteal lesions. Before ER, the patients underwent CE-MRA with cuff compression and DSA for arterial disease, their runoff vessels were detected with CE-MRA but not with DSA. The preoperative findings for runoff vessels both on MRA and DSA scans were graded according to the revised version of the ad hoc scoring system. Antegrade intraluminal angioplasty was attempted to recanalize the occlusive lesion; in cases where intraluminal angioplasty failed, subintimal angioplasty as well as retrograde revascularization via the pedal arch loop were performed subsequently.Immediate and follow-up postoperative outcomes were assessed. Univariate analysis was performed to identify the variables associated with successful ER.

Successful ER was achieved in 85.7% (84/98) limbs, and the runoff score (5.1 ± 1.1) was significantly smaller than that in the failed limbs (6.2 ± 1.3). Clinical improvement was noted in 85% of the successfully treated limbs. The restenosis and reocclusion rate of the target lesions was 61.1% and 12.6% respectively at 3 months, and 75.9% and 15.6 % respectively at 12 months after ER. The 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).

Runoff vessels detected using CE-MRA could indicate immediate success and better outcome of ER for infrapopliteal occlusions.

CE-MRA was superior to DSA in the detection of patent runoff vessels, and potential runoff vessels detected on CE-MRA could be a predictor for immediate success and better outcomes of ER in occluded infrapopliteal vessels. Therefore, the dynamic CE-MRA protocol with high temporal and spatial resolution could be a meaningful adjunct in patients with extensive infrapopliteal lesions.

Zhao, J, Patency of Runoff Detected by MR Angiography at 3.0 T with Cuff-compression: A Predictor of Successful Endovascular Recanalization below the Knee.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003716.html