Gadofosveset is the first gadolinium-based magnetic resonance (MR) imaging agent designed to image the blood pool. At clinically relevant concentrations, gadofosveset is highly bound to human serum albumin, which has the effect of increasing its signal-enhancing properties above that of non-protein bound imaging agents, as well as increasing its plasma half-life, allowing for increased imaging times. The use of gadofosveset-enhanced MR angiography was compared with non-enhanced MR angiography in four open-label, multicentre studies in adults with known or suspected arterial disease. Significant improvements in the accuracy and specificity of diagnosis were seen with gadofosveset in patients with aortoiliac disease in two studies. Sensitivity was also improved, with all three readers in one study, and two of three readers in the other study, showing significant improvements with gadofosveset use. Significant improvements in sensitivity, specificity, and accuracy were also seen with gadofosveset in a renal artery disease study. Specificity was significantly improved in patients with pedal artery disease across all readers, with accuracy and sensitivity significantly improved in two of three and one of three readers. Gadofosveset was generally well tolerated in clinical trials, with most adverse events being mild or moderate in severity.