HomeAbout UsLocationsContact UsOur PhysiciansLinksNewsEmployment

Narrowing of the blood vessels to the legs can cause a variety of symptoms including cramping during walking (claudication), pain in the legs with rest (rest pain), or non-healing wounds or ulcers of the legs and feet. People at risk include smokers, diabetics, patients with high cholesterol, or people with strong family history for vascular disease.

Medical work-up must consider or eliminate other common causes of leg symptoms. This can usually be done accurately through a combination of medical history, physical exam and noninvasive vascular studies that include blood pressure measurements of the arms and legs (ABI’s).

Once vascular disease is identified as the cause, and the symptoms are felt to be sufficient to warrant treatment, catheter angiography is performed. This time proven method is an accurate gold standard for diagnosis. It also allows efficient, and effective treatment of some abnormalities during the same procedure (angioplasty). During angioplasty, a balloon is placed through the catheter, expanding the narrowing in the blood vessel. A supportive strut, or stent is often then placed. Long term success of such treatment is excellent in the vessels of the pelvis (iliacs) or upper thighs. Narrowings lower in the leg are often candidates for surgical bypass.

Because the contrast dye used during catheter angiography can worsen kidney function, patients with known kidney dysfunction are candidates for MR angiography (MRA). This has a particular role in diabetics with a combination of limb threatening ischemia (for example a non healing foot ulcer) and renal dysfunction. MRA has the advantage of requiring only an I.V. injection of a kidney safe contrast agent (gadolinium). The state of the art Siemens Symphony 1.5 Tesla MR scanner at St. Mary’s Hospital operated by Turville Bay MRI Centers utilizes a dedicated vascular coil, moving table technique and high resolution methods to produce high quality images.

As the image quality of MRA is now excellent, patients may be selected for catheter angiography based on their likelihood of having iliac disease based on noninvasive testing. Catheter angiography is preferred in these patients since curative angioplasty can be performed at the same time as the catheter angiogram. The remainder of patients who may be potential surgical candidates based on noninvasive testing may be better candidates for MRA. Patients with renal dysfunction are also excellent candidates for MRA, thereby avoiding the kidney toxicity of iodine based contrast.

Newer MR techniques and contrast agents on the horizon will even further advance the quality of these studies in the near future.

The following sample image is typical:

click on picture to view full size

High grade right external iliac stenosis with excellent demonstration of three vessel runoff bilaterally

Other Services

Peripheral Angiography and Angioplasty
Diagnostic angiography and therpeutic angioplasty and stenting for treatment of peripheral vascular disease

Multi-Detector Row CT
These scanners change the way physicians look at scans

CT of Acute Abdominal Pain
Analysis of the role of CT in the setting of acute abdominal pain

Aorta and Great Vessels
MRI and CT can beautifully demonstrate abnormalities previously requiring catheter angiography

Positron Emission Tomography (PET)
Positron Emission Tomography (PET imaging) has exploded into the medical imaging arena

MRI of the Pelvis
The role of MRI in benign and malignant disease of the uterus, cervix and ovaries

Advances in MR Imaging
Non-invasive methods to image bile ducts and other static fluids

Cardiac MRI
Rapidly advancing method to evaluate ischemic heart disease and for the detection of hibernating myocardium

Uterine Artery Embolization
A non-surgical alternative to hysterectomy for the treatment of fibroid tumors of the uterus

Percutaneous Vertebroplasty
Method to treat painful spinal compression fractures

Carotid and Vertebral Artery Stenting
A new technique as an alternative to surgical endarterectomy in specific circumstances

Aneurysm Coiling
Alternative to surgical treatment of cerebral aneurysms in specific circumstances

Renal Artery Stenosis Screening
For the evaluation of medically resistant high blood pressure