Omaida C. Velázquez, Richard A. Baum, Jeffrey P. Carpenter

Improvements in vascular technique have expanded the treatment options for patients with severe occlusive peripheral vascular disease. The decision to perform a major revascularization procedure in patients who are often at high risk for cardiovascular morbidity and mortality depends on the risk-benefit ratio. Detailed and accurate vascular imaging is essential and evaluating the likelihood of a successful revascularization with subsequent limb salvage. Although contrast angiography has been the time-honored reference standard imaging technique, the method is an invasive procedure with limitations and risks. MRA is a new, noninvasive vascular imaging technique that may now be added to the imaging options with the potential for improved sensitivity for finding patent runoff vessels, avoidance of morbidity, and cost equivalent to that of conventional contrast angiography. Magnetic resonance angiography is a rapidly developing and exciting new vascular imaging technique. As with any new technique, it is imperative that individual centers validate their MRA results and interpretations against the time-honored standard, which continues to be contrast arteriography. Several studies now indicate that MRA can be a cost-effective outpatient imaging technique sufficient for planning and successfully performing peripheral bypass procedures. As developments in hardware, software, and non-nephrotoxic contrast agents continue to increase, applicability of MRA in vascular surgery will continue to expand. Predictably, MRA will have a major role in the future of vascular imaging, and it is likely to supplant the need for conventional contrast angiography in the majority of patients.