Best Duplex-Sonographic Criteria for the Assessment of Renal Artery Stenosis - Correlation with Intra- Arterial Pressure Gradient

Staub, Daniel; Canevascini, Reto; Huegli, Rolf W.; Aschwanden, Markus; Thalhammer, Christoph; Imfeld, St.; Singer, Ellis P.; Jacob, Augustinus Ludwig; Jaeger, Kurt A.

doi:10.1055/s-2007-962881

Cited by 59 publications

(68 citation statements)

References 15 publications

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“…However, this criterion is not commonly used in our practice. Unlike obstructive uropathy [40,41], the abnormal kidney will show reduced RIs beyond the point of stenosis [42].…”

Section: Distal Criteria (Indirect Evaluation Of the Stenosis)mentioning

confidence: 99%

Doppler ultrasound and renal artery stenosis: An overview

Granata

Fiorini²,

Andrulli

et al. 2009

Journal of Ultrasound

104

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KEYWORDSDoppler ultrasound; Ischemic nephropathy; Renal artery stenosis; Renovascular disease.Abstract Renovascular disease is a complex disorder, most commonly caused by fibromuscular dysplasia and atherosclerotic diseases. It can be found in one of three forms: asymptomatic renal artery stenosis (RAS), renovascular hypertension, and ischemic nephropathy. Particularly, the atherosclerotic form is a progressive disease that may lead to gradual and silent loss of renal function. Thus, early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Screening for RAS is indicated in suspected renovascular hypertension or ischemic nephropathy, in order to identify patients in whom an endoluminal or surgical revascularization is advisable. Screening tests for RAS have improved considerably over the last decade. While captopril renography was widely used in the past, Doppler ultrasound (US) of the renal arteries (RAs), angio-CT, or magnetic resonance angiography (MRA) have replaced other modalities and they are now considered the screening tests of choice. An arteriogram is rarely needed for diagnostic purposes only. Color-Doppler US (CDUS) is a noninvasive, repeatable, relatively inexpensive diagnostic procedure which can accurately screen for renovascular diseases if performed by an expert. Moreover, the evaluation of the resistive index (RI) at Doppler US may be very useful in RAS affected patients for predicting the response to revascularization. However, when a discrepancy exists between clinical data and the results of Doppler US, additional tests are mandatory.Sommario La malattia nefrovascolare è un disordine complesso e le cause più comuni sono la malattia aterosclerotica e la displasia fibromuscolare. Classicamente si presenta in una delle seguenti tre forme: stenosi dell'arteria renale (SAR) asintomatica, associata a ipertensione nefrovascolare e/o con nefropatia ischemica. La SAR su base aterosclerotica è una malattia progressiva che può determinare in maniera asintomatica o paucisintomatica perdita graduale della funzione renale. Per tale motivo, la diagnosi precoce di SAR è un obiettivo clinico importante poiché la terapia interventistica può migliorare o curare l'ipertensione e preservare la funzione renale. Lo screening per SAR è indicato nel sospetto di ipertensione nefrovascolare o di nefropatia ischemica al fine di identificare i pazienti in cui è indicato un intervento di rivascolarizzazione. I test di screening per SAR sono migliorati considerevolmente durante l'ultimo decennio. Mentre la scintigrafia con test al captopril è stata utilizzata quasi esclusivamente nel passato, l'ecocolorDoppler delle arterie renali, l'angioTC e/o l'angioRM hanno sostituito le altre modalità di screening in molti centri. Per tale motivo l'arteriografia riveste sempre più un ruolo interventistico e solo di rado diagnostico. L'ecocolorDoppler è una procedura diagnostica non invasiva, ripetibile e relativamente economica che negli ultim...

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“…However, this criterion is not commonly used in our practice. Unlike obstructive uropathy [40,41], the abnormal kidney will show reduced RIs beyond the point of stenosis [42].…”

Section: Distal Criteria (Indirect Evaluation Of the Stenosis)mentioning

confidence: 99%

Doppler ultrasound and renal artery stenosis: An overview

Granata

Fiorini²,

Andrulli

et al. 2009

Journal of Ultrasound

104

View full text Add to dashboard Cite

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“…Staub et al [29] found in 49 retrospectively analyzed patients a good correlation between duplex sonography measurements and the severity of arteriographic diameter reduction with systolic pressure gradients. The clinically expedient duplex sonography criteria for detecting RAS of ≥ 50 % are a PSV of ≥ 200 cm/sec or an RAR of ≥ 2.5.…”

Section: Discussionmentioning

confidence: 99%

Duplex derived intrarenal resistance index correlates with invasive pressure gradient measurements in detecting relevant unilateral renal artery stenosis

Noory

Rastan

Beschorner

et al. 2016

Vasa

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Summary:Background: The purpose of this study was to assess the correlation between the transstenotic pressure gradient as determined by a pressure wire and the decrease in the intrarenal resistance index (RI) > 0.05 measured by duplex ultrasound in signifi cant unilateral renal artery stenosis (RAS). Intravascular ultrasound (IVUS) was correlated to the angiographic degree of RAS. Patients and methods: In 17 patients, transstenotic pressure gradient measurements, IVUS and RI measurements were obtained before and after stenting. After stenting, graded stenosis was created by progressive balloon catheter infl ation. Stenosis severity was expressed as the ratio of the distal pressure (Pd) corrected for aortic pressure (Pa). The balloon infl ation pressure was adjusted to create a stenosis with Pd/Pa ratio 1.0 to 0.7. In parallel, RI measurements were performed in the affected kidney and compared to the contralateral kidney for the calculation of the side-difference in RI. IVUS was performed to correlate the cross-sectional degree of stenosis with quantitative angiography (QA). Results: In 60 out 68 measurements, the RI difference (decline > 0.05) correlated with a Pd/Pa ratio < 0.9; this correlation was signifi cant by linear regression analysis (p < 0.001). The preinterventional mean degree of stenosis was 63.4 % + 16.1 (24.6 -84.6 %) as assessed by QA and 76.7 % + 13.2 % (47 -92 %) as assessed by IVUS, showing a signifi cant correlation (p < 0.035). Conclusions: In unilateral RAS, a drop in RI > 0.05 as compared to the unaffected kidney correlates to an invasively measured Pd/Pa ratio < 0.9, which is regarded as a signifi cant pressure gradient associated with increased renin production, which promotes renovascular hypertension. QA underestimates RAS severity as compared to IVUS.

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“…Before intervention, duplex ultrasound was always confirmed by intra-arterial angiography showing a percent diameter stenosis ≥50% by measuring the ratio between the diameter of the narrowest segment of the imaged renal artery and the diameter of a normal segment of the artery proximal to the stenosis or distal to poststenotic dilation. Alternatively, an intra-arterial, trans-lesional systolic pressure gradient of ≥20 mmHg was considered as hemodynamically relevant and was assessed in 31 patients (6). A RAS ≥70% was documented in 84% of all patients and mean systolic pressure gradient was 72±46 mmHg.…”

Section: Patient Populationmentioning

confidence: 99%

“…Assessment of RAS was based primarily on duplex ultrasound using a Philips ATL, HDI 5000 (Philips, Best, Netherlands). As described previously, RAS was classified as hemodynamically relevant if the renal/aortal velocity ratio was ≥2.5 (6). For unilateral RAS the side-to-side difference in intrarenal RI =1-[end-diastolic velocity/peak systolic velocity] between the 2 kidneys >0.05 was also used to classify hemodynamically relevant RAS.…”

Section: Patient Populationmentioning

confidence: 99%

Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis

Staub¹,

Partovi²,

Zeller³

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Identifying patients likely to have improved renal function after percutaneous transluminal renal angioplasty and stenting (PTRA) for renal artery stenosis (RAS) is challenging. The purpose of this study was to use a comprehensive multimarker assessment to identify those patients who would benefit most from correction of RAS. Methods:In 127 patients with RAS and decreased renal function and/or hypertension referred for PTRA, quantification of hemodynamic cardiac stress using B-type natriuretic peptide (BNP), renal function using estimated glomerular filtration rate (eGFR), parenchymal renal damage using resistance index (RI), and systemic inflammation using C-reactive protein (CRP) were performed before intervention.Results: Predefined renal function improvement (increase in eGFR ≥10%) at 6 months occurred in 37% of Conclusions: Quantification of renal function, but not any other pathophysiologic signal, provides at least moderate accuracy in the identification of patients with RAS in whom PTRA will improve renal function.

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Best Duplex-Sonographic Criteria for the Assessment of Renal Artery Stenosis - Correlation with Intra- Arterial Pressure Gradient

Cited by 59 publications

References 15 publications

Doppler ultrasound and renal artery stenosis: An overview

Doppler ultrasound and renal artery stenosis: An overview

Duplex derived intrarenal resistance index correlates with invasive pressure gradient measurements in detecting relevant unilateral renal artery stenosis

Multimarker assessment for the prediction of renal function improvement after percutaneous revascularization for renal artery stenosis

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