Published in:
01-11-2014 | Vascular-Interventional
Patency of runoff detected by MR angiography at 3.0 T with cuff-compression: a predictor of successful endovascular recanalization below the knee
Authors:
Yue-Qi Zhu, Jun-Gong Zhao, Jue Wang, Hua-Qiao Tan, Hai-Tao Lu, Fang Liu, Ying-Sheng Cheng, Li-Ming Wei, Pei-Lei Zhang
Published in:
European Radiology
|
Issue 11/2014
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Abstract
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