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PROPEL-MRA: Probing Tibial Patency With MRA For Enhanced Limb Preservation In Chronic Limb Threatening Ischemia
Madeline Drake, MD, Paul Haddad, MD, Bright Benfor, MD, Alexander Crichton, MD, Judit Csore, MD PhD, Trisha Roy, MD PhD.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES:Therapeutic options available to patients with chronic limb-threatening ischemia (CLTI) depend heavily on the patency of distal run-off vessels. The gold standard of imaging for these vessels has long been digital subtraction angiography (DSA) which allows for simultaneous therapeutic intervention. However, DSA is an invasive procedure and up to 20% of patients will fail intervention. We present data that confirms the use of non-contrast magnetic resonance angiography (MRA) provides a sensitive assessment of popliteal and tibial artery patency in CLTI patients. METHODS This is a single center retrospective review of 31 CLTI patients who underwent MRA imaging using Quiescent-Interval Slice Single-Shot (QISS) protocol during their preoperative workup followed by DSA. The vessels evaluated were the popliteal artery, tibioperoneal trunk (TPT), anterior tibial artery (ATA), posterior tibial artery (PTA), peroneal artery, and dorsalis pedis artery (DPA). Traditional popliteal artery segments (P1, P2, and P3) were used for patency evaluation. The ATA, PTA, and peroneal arteries were divided into proximal, middle, and distal for evaluation. The TPT and DPA were evaluated as one segment each. The proportion of patent segments identified by each imaging modality was compared using a McNemar test in a two-tailed fashion and a p-value < 0.05 was considered significant. RESULTS MRA was able to detect more patent vessels than DSA in all arterial beds evaluated. These findings were noted to be statistically significant in the entire popliteal artery, entire ATA, middle PTA, middle peroneal artery, and DPA. Findings are listed in Table 1. CONCLUSIONS The superiority of non-contrast MRA compared to DSA in detecting distal run-off vessels has been documented. Here we have reinforced the utility of MRA in detecting angiographically occult vessels using the QISS protocol in a new era of CLTI care that is routinely employing MR technology as part of the limb salvage pathway. This study and further investigation intend to highlight the use of preoperative MRA to improve procedural planning, eliminate diagnostic angiography, and reduce failed endovascular interventions.
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