Introduction: This study evaluates the role of mr angiography in peripheral arterial disease in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a prospective comparative analysis. Materials and Methods: A prospective comparative study was conducted on 310 patients from April 2017 to December 2023 at a tertiary care center. Patients were divided into MRA-planned (n=155) and DSA-planned (n=155) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The MRA-planned group demonstrated significantly improved primary outcomes compared to DSA-planned (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.