Surveillance of Peripheral Arterial Bypass Grafts with Three-Dimensional MR Angiography
Comparison with Digital Subtraction Angiography
K. Bertschinger1,2,
Paolo C. Cassina3,
Jörg F. Debatin1,2 and
Stefan G. Ruehm1,2
1
Institute of Diagnostic Radiology, University Hospital,
Rämistr. 100,
Zürich, Switzerland.
2
Present address: Institute of Diagnostic Radiology, University Hospital Essen,
Hufelandstr. 55, D-45122 Essen, Germany.
3
Department of General Surgery, University Hospital,
Zürich, Switzerland.
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Fig. 1A. —67-year-old man with peripheral vascular occlusive disease 3
years after surgical treatment with expanded polytetrafluoroethylene
femorofemoral bypass graft of left leg. Maximum-intensity-projection MR image
shows occluded superficial femoral artery (arrow) and patent bypass
graft in left leg (arrowheads). Note excellent depiction of run-off
vessels in both legs.
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Fig. 1B. —67-year-old man with peripheral vascular occlusive disease 3
years after surgical treatment with expanded polytetrafluoroethylene
femorofemoral bypass graft of left leg. Conventional catheter digital
subtraction angiogram performed 3 days before MR angiography shows normal
bypass graft in left leg. Note irregular superficial femoral artery in right
leg.
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Fig. 2A. —55-year-old man now suffering from peripheral vascular
occlusive disease after extensive graft surgery of left and right legs 7 and 8
years ago, respectively. Conventional radiograph reveals presence of covered
6-mm stent in proximal venous bypass graft.
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Fig. 2B. —55-year-old man now suffering from peripheral vascular
occlusive disease after extensive graft surgery of left and right legs 7 and 8
years ago, respectively. MR angiogram shows typical artifact (large
arrowheads) caused by signal void of stent in proximal portion of
femoropopliteal bypass graft in left leg. Significant stenoses (small
arrowheads) in middle of graft course are seen. In addition, this patient
has patent femoropopliteal bypass graft in right leg.
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Fig. 2C. —55-year-old man now suffering from peripheral vascular
occlusive disease after extensive graft surgery of left and right legs 7 and 8
years ago, respectively. Conventional catheter digital subtraction angiogram
of left leg obtained 2 weeks after MR angiography revealed patent proximal
anastomosis and proximal graft course. Significant graft stenoses
(arrowheads) distal to stent were confirmed.
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Fig. 3A. —80-year-old man 5 years after graft surgery using expanded
polytetrafluoroethylene graft for treatment of peripheral vascular occlusive
disease. Rotated (60° to left) maximum intensity projection of
three-dimensional MR angiogram reveals significant stenosis
(arrowhead) affecting proximal anastomosis of expanded
polytetrafluoroethylene femoropopliteal bypass graft in left leg. Right
superficial femoral artery is occluded.
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Fig. 3B. —80-year-old man 5 years after graft surgery using expanded
polytetrafluoroethylene graft for treatment of peripheral vascular occlusive
disease. Significant stenosis (arrowheads) of proximal anastomosis is
confirmed on detailed conventional catheter digital subtraction angiogram
obtained the next day.
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Fig. 4A. —78-year-old woman 5 years after implantation of homologous
venous graft into left leg. Ectatic femoropopliteal bypass graft
(arrows) in left leg for treatment of peripheral occlusive disease
and normally patent proximal and distal anastomoses are seen to good advantage
on maximum intensity projections of three-dimensional MR angiography data set.
Superficial femoral arteries are occluded bilaterally.
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Fig. 4B. —78-year-old woman 5 years after implantation of homologous
venous graft into left leg. Conventional catheter digital subtraction
angiogram of left leg 1 day after A confirmed ectasia of lower part of
graft and normal anastomoses.
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Fig. 5A. —69-year-old man treated 8 years before for peripheral
vascular disease by placement of expanded polytetrafluoroethylene
femoropopiteal bypass graft. Three-dimensional MR angiogram shows artifacts
from nitinol ligating clips in proximity of graft mimicking stenoses in two
locations (arrowheads). Note also occluded popliteal artery just
distal to distal anastomosis (arrows), resulting in flow across
distal anastomosis, with retrograde flow in popliteal artery below knee.
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Fig. 5B. —69-year-old man treated 8 years before for peripheral
vascular disease by placement of expanded polytetrafluoroethylene
femoropopiteal bypass graft. Conventional catheter digital subtraction
angiogram (DSA) of left leg confirms occlusion of popliteal artery
(arrow) and shows graft course that is irregular but without any
significant stenoses (arrowheads).
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Fig. 5C. —69-year-old man treated 8 years before for peripheral
vascular disease by placement of expanded polytetrafluoroethylene
femoropopiteal bypass graft. Coronal MR source image at level of mid graft
shows susceptibility-induced signal voids (arrows) typical of clips.
These artifacts are readily recognized because of characteristic build-up of
signal on one side.
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Fig. 5D. —69-year-old man treated 8 years before for peripheral
vascular disease by placement of expanded polytetrafluoroethylene
femoropopiteal bypass graft. Detailed DSA of distal graft portion shows
ligating clips near graft (arrowheads) and occluded popliteal artery
(arrow).
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Copyright © 2001 by the American Roentgen Ray Society.
