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Fig. 4.17 Magnetic resonance angiography (MRA) showing multiple areas of stenosis and occlusion through the right and left superficial femoral arteries and in the left popliteal artery. Courtesy of Dr Paul Sidhu.

It is slow, lasting up to 2 h, to cover the area from the bifurcation of the aorta to the distal lower extremity

• Gadolinium-enhanced MRA involves an intravenous injection of gadolinium contrast and a fast imaging that follows the passage of the contrast bolus through the arteries. It is much less nephrotoxic than conventional contrast (Fig. 4.17).

The advantages of MRA against conventional trans-femoral angiography are that there is no need for an intraarterial catheter and nephrotoxic contrast can be avoided.

Having carried out these non-invasive procedures to map out the arterial system, it is now possible to focus treatment by performing transfemoral angiography, together with digital subtraction angiography, followed by angioplasty or arterial bypass.

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