Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis

AbuRahma, Ali F.; Srivastava, Mohit; Mousa, Albeir Y.; Dearing, David D.; Hass, Stephen M.; Campbell, James; Dean, Larry S.; Stone, Patrick A.; Keiffer, Tammi

doi:10.1016/j.jvs.2012.03.036

Cited by 47 publications

(25 citation statements)

References 42 publications

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“…Color Doppler ultrasonography can often detect stenosis of the renal artery, particularly when localized close to the vessel origin 45. It also allows determination of the resistance index, which predicts the outcome of angioplasty and stenting in atherosclerotic renal artery stenosis 45.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…It also allows determination of the resistance index, which predicts the outcome of angioplasty and stenting in atherosclerotic renal artery stenosis 45. An increased resistance index suggests structural abnormalities in the small vessels of the kidney, and benefit from renal revascularization has been reported in patients with a resistance index <80 46.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…In a study of more than 300 patients using both duplex ultrasonography and angiography, peak systolic velocity and the systolic renal to aortic ratio was accurate for diagnosing a 60% renal artery stenosis. Specific data for 14 FMD patients in this study were not provided 45. In atherosclerotic renal artery stenosis, ultrasonographic evaluation may therefore identify the majority of patients with less than 60%–70% stenosis, in whom further investigations are not needed.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Optimal management of renal artery fibromuscular dysplasia

Gottsäter¹,

Lindblad²

2014

TCRM

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Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the “string of beads” appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels. The etiology is multifactorial, including vessel wall ischemia and smoking, as well as hormonal and genetic factors. Intra-arterial digital subtraction angiography is still the gold standard for exclusion or confirmation of renal artery stenosis caused by FMD, at least in young patients, who more often have lesions in branches of the renal artery. For FMD patients with atherosclerosis and those who are older (>50–55 years), significant renal artery stenosis may be confirmed or excluded with ultrasonography. The FMD lesion is typically truncal or distal, whereas atherosclerotic lesions are more often proximal or ostial. Treatment options are medical, endovascular (percutaneous transluminal renal angioplasty [PTRA]), and surgical. Invasive treatment should be considered when hypertension cannot be controlled with antihypertensive drugs and in patients with impaired renal function or ischemic nephropathy. PTRA has become the treatment of choice and normally yields good results, especially in unifocal disease and young patients. Pressure gradients are normally completely abolished, and there is no indication for stent placement. Surgical revascularization is indicated after PTRA complications; thrombosis, perforation, progressive dissection, repeated PTRA failure or restenosis. Centralization of handling is recommended.

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Section: Diagnostic Evaluationmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

Section: Diagnostic Evaluationmentioning

confidence: 99%

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Optimal management of renal artery fibromuscular dysplasia

Gottsäter¹,

Lindblad²

2014

TCRM

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“…Клинически ВГА проявляется вторичными (системными) арте риальными гипертензиями (ВАГ), среди которых наиболее распространенными формами являются паренхиматозные заболевания почек и поражения почечных сосудов [3]. Реноваскулярные заболевания составляют от 1 до 5% среди всех случаев артериальной гипертензии [4]. Это гетерогенная группа патологий, к которой относятся: атеросклероз почечных артерий, встречающийся в большинстве случаев -90%; фибромускулярная дисплазия (ФМД) -10%; другие более редкие патологии, сопровождающиеся сужением просвета почечных сосудов: аневризмы, врожденные или травматические артериовенозные фистулы, васкулиты, нейрофиброматоз, травмы, эмболии, пост радиационная терапия, расслоение почечных артерий [5].…”

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“…Скорость клубочковой фильтрации (СКФ) соответствовала второй стадии хронической болезни почек (ХБП) (СКФ по формуле MDRD -67 мл/мин/1,73 м 2 ). Исследование уровня электролитов крови в сы-ческого шума в проекции почечных сосудов [4,8,10]. Инструментальные методы диагностики ФМД почечных сосудов включают в себя проведение УЗДГ почечных сосудов, МСКТ, магнитнорезонансную ангиографию (МРА) почечных сосудов, однако "золотым стандартом" является конт растная ангиография (КАГ) почечных сосудов [4,[8][9][10].…”

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