In the first phase of this study, seven healthy subjects underwent examination with two-dimensional time-of-flight (TOF) magnetic resonance (MR) angiography to develop a protocol for evaluation of peripheral arterial vasculature from the infrarenal aorta to the foot. In the second phase, 73 patients with symptomatic peripheral vascular disease underwent examination with both conventional contrast material-enhanced arteriography and two-dimensional TOF MR angiography to evaluate the clinical usefulness of MR angiography. Postinterventional and intraoperative angiography or direct surgical exploration was the standard of reference. In 32 patients, discrepancies occurred between findings on arteriograms and those on MR angiograms; most of these discrepancies were caused by improved depiction of runoff vessels on MR angiograms. The demonstration with MR angiography of blood vessels not seen on conventional arteriograms, unidentified stenoses, or misidentified blood vessels altered surgical management in 12 patients (16%). Metal-clip artifacts obscured clinically important disease on MR angiograms in two patients. It is concluded that two-dimensional TOF MR angiography is very useful in preoperative assessment of patients with severe peripheral vascular disease.