Name of the Procedure:

Magnetic Resonance Angiography (MRA) with contrast, lower extremity
Common Names: MRA Lower Extremity, MR Angiography with contrast

Summary

Magnetic Resonance Angiography (MRA) with contrast for the lower extremity is a non-invasive imaging procedure used to visualize blood vessels in the legs. It involves the use of magnetic resonance imaging (MRI) technology along with a contrast agent to enhance the clarity and detail of the images.

Purpose

Medical Conditions Addressed:

• Peripheral artery disease (PAD)
• Blood clots
• Aneurysms
• Stenosis (narrowing) of blood vessels
• Other vascular abnormalities

Goals/Expected Outcomes:

• Identification of blockages or abnormalities in blood vessels
• Planning for potential surgical or interventional procedures
• Monitoring the effectiveness of previous treatments

Indications

Symptoms/Conditions Warranting the Procedure:

• Leg pain, especially during exercise (claudication)
• Poor wound healing in the legs
• Swelling or edema in the lower extremities
• Unexplained leg pain or discomfort

Patient Criteria:

• Patients with known or suspected vascular disease
• Individuals with risk factors for vascular disease, such as diabetes, smoking, or high blood pressure
• Patients who have had abnormal results from other vascular tests

Preparation

Pre-Procedure Instructions:

• Fasting for 4-6 hours prior to the exam
• Inform the medical team of any allergies, particularly to contrast agents
• Adjustments to medication as directed by the healthcare provider (e.g., blood thinners)
• Remove any metal objects or jewelry

Pre-Procedure Assessments:

• Blood tests to check kidney function (to ensure safe use of contrast)
• Review of patient’s medical history and current medications

Procedure Description

1. Preparation:

   • Patient changes into a hospital gown and lies on the MRI table.
   • An intravenous (IV) line is inserted to administer the contrast agent.

2. Imaging:

   • The MRI technologist moves the table into the MRI scanner.
   • Initial scans may be taken without contrast.
   • Once initial scans are complete, the contrast agent is injected through the IV line.

3. Contrast Imaging:

   • Further scans are taken to capture enhanced images of the blood vessels.

4. Completion:

   • The IV line is removed, and the patient is helped off the table.

Tools/Equipment Used:

• MRI machine
• Contrast agent (gadolinium-based)
• IV line and injections

Anesthesia/Sedation:

• Generally not required, but some patients may need mild sedation if they are claustrophobic.

Duration

The procedure typically takes between 30 to 60 minutes, depending on the complexity.

Setting

MRA with contrast for the lower extremity is usually performed in a hospital's radiology department or an outpatient imaging center.

Personnel

• Radiologist (specialist doctor)
• MRI technologist
• Nurse (to assist with IV)

Risks and Complications

Common Risks:

• Allergic reaction to the contrast agent
• Mild discomfort or bruising at the IV site

Rare Risks:

• Nephrogenic systemic fibrosis in patients with severe kidney issues
• Contrast-induced nephropathy (rare kidney complication)

Complication Management:

• Immediate treatment for allergic reactions
• Pre-procedure screening for kidney issues to minimize risk

Benefits

Expected Benefits:

• Accurate and detailed images of blood vessels
• Helps in diagnosing and planning effective treatments
• Non-invasive with no radiation exposure

Realization Time:

• Results are typically available within a few days, with interpretation by a radiologist.

Recovery

Post-Procedure Care:

• Patients can usually resume normal activities immediately
• Increased hydration to help flush out the contrast agent
• Monitor IV site for any signs of infection or complications

Expected Recovery Time:

• Minimal to no downtime required

Follow-Up Appointments:

• As advised by the healthcare provider, based on findings

Alternatives

Other Treatment Options:

• Computed Tomography Angiography (CTA)
• Doppler Ultrasound
• Traditional Angiography

Pros and Cons of Alternatives:

• CTA: Faster and with high detail but involves radiation exposure
• Doppler Ultrasound: Non-invasive and no contrast needed but less detailed
• Traditional Angiography: Highly detailed but more invasive and involves radiation

Patient Experience

During the Procedure:

• May feel coolness from the contrast injection
• Need to remain still
• Some noise from the MRI machine, usually managed with earplugs or headphones

Post-Procedure:

• Typically, no significant discomfort
• Follow standard post-IV care instructions

Pain Management:

• Typically not necessary, mild pain if any can be managed with over-the-counter analgesics