History:
72 year-old female presents with
severe bilateral calf and foot pain with walking.
She was referred to Main Street
Radiology for Magnetic Resonance Angiography (MRA) of the abdomen,
pelvis and lower extremities.
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Findings:
Anterior MRA images (Figure 1) show moderate focal stenosis of the
distal aorta (arrow #1). The right iliac arteries are occluded (arrows
#2). There is occlusion of the left superficial femoral artery (arrow
#3). The left popliteal artery is reconstituted just below Hunter's
Canal and is mildly stenotic (arrow #4).
Lateral MRA image of the right calf and
foot (Figure 2) shows single vessel runoff via a widely patent
peroneal artery (arrow #5), which supplies the posterior tibial artery
via a collateral (arrow #6). It fills the dorsalis pedis and distal
anterior tibial artery (arrow #7) in a retrograde fashion via a patent
pedal arch. The anterior and posterior tibial arteries are occluded in
the calf.
Anterior images (Figure 1) show two
vessel runoff on the left side via the peroneal and posterior tibial
arteries (arrows #8). Lateral MRA image of the left calf and foot
(Figure 3) shows patent but attenuated plantar arteries (arrow #9) and
occluded dorsalis pedis (arrow #10).
Discussion:
Peripheral vascular disease (PVD)
affects approximately 10 million people in the United States and about
1 in 20 people over the age of 50. Despite being symptomatic in more
than half of these people, less than a quarter receive any form of
treatment. Many patients mistakenly believe that the symptoms are a
normal part of aging.
The most common symptom of PVD is
reproducible painful cramping in the legs or buttocks, particularly
when walking, that resolves with rest (claudication). Other symptoms
include numbness, tingling, burning, cold leg or foot, as well as skin
breakdown and non-healing ulcers or infections. The risk factors
include: age over 50, smoking, diabetes, obesity, lack of exercise,
hypertension, and high cholesterol. Patients can often be treated
using percutaneous techniques.
Peripheral MRA is performed routinely
at MSR on our high-field magnet using the latest 3D dynamic and
time-resolved protocols. With time-resolved MRA, multiple images are
sequentially acquired at 10 second intervals. After 3D post
processing, the subsequent images are very similar to a conventional
angiogram. The entire exam takes less than 40 minutes and is
non-invasive. It does require an IV injection of Gadolinium, which is
not nephrotoxic.
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