OBJECTIVES: Evaluation of peripheral vascular disease in the primary care setting is routinely performed by contrast enhanced magnetic resonance angiography (ce-MRA) and digital subtraction angiography (DSA). However, limited data is available on the clinical outcomes following these diagnostic procedures. METHODS: We identified individuals who underwent an outpatient ce-MRA (3,444) or DSA (16,899) procedure of the lower extremities from 1998 to 2004 in the U.S. Veterans Healthcare System. Interventions (revascularization, stent, angioplasty), amputations or mortality rates within one year of DSA or ce-MRA were assessed, while complications within 30 days were compared for both groups adjusted for baseline characteristics using log-binomial regression.RESULTS: Approximately 31% of the patients had an intervention after imaging with a greater proportion having an intervention following DSA (36% vs. 20%; P <0.001). Similarly, amputations (without interventions) were more common after DSA (8% vs. 4%; P <0.001). Mortality within one year was comparable in both groups (6.9% vs. 6.2%). Overall complications were 2.0%, majority of the events were vascular complications including hematomas (70.5%). Vascular complications were more frequent following a DSA as compared to ce-MRA (1.7% versus 0.4%). In multivariable-adjusted models complications were lower after a ce-MRA then a DSA procedure (RR, 0.47; 96% CI, 0.34-0.65). CONCLUSION: Imaging leading to an intervention occurred only in about a third of subjects. Overall complications rates were low but higher after DSA. A greater understanding of clinical predictors, timing and cost-benefit of diagnostic imaging is needed to determine the best course of action to assess and reduce the morbidity associated with PVD.