The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization

Abstract

Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACC ≤ 1.3 m/s) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.

Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study

“…Previous research 13,[15][16][17][18] and our study both show that ACC max is a feasible noninvasive technique for assessing the severity of PAD and renal artery stenosis. In contrast, other duplex parameters are limited to identify the severity of a PAD (particularly at multilevel stenoses).…”

“…To circumvent this bias, maximal systolic acceleration (ACC max ) was introduced. Importantly, ACC max has been shown to have diagnostic value in renal artery stenosis, [15][16][17][18] and van Tongeren et al 13 and Buschmann et al 14 showed that ACC max is an accurate noninvasive tool for diagnosing PAD, also in diabetic patients who often have a higher degree of medial calcific sclerosis. In addition, determining the severity of PAD in patients with CLI can be challenging as a result of the presence of noncompressible arteries.…”

“…Van Tongeren et al 13 and Buschmann et al 14 showed the accurate diagnostic properties of ACC max , also in diabetic patients. Although ACC max has already been used to detect renal artery stenosis, [15][16][17][18] to our knowledge, it has not been evaluated thoroughly for PAD. We think that if you want to introduce a new parameter to diagnose PAD, you must start from basic principles.…”

A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration

“…Bardelli et al 18 described the novel ACCmax in 2006 for detection of renal artery stenosis. Subsequently several clinical studies were published about the ACCmax in renal artery stenosis 17,19,20 and peripheral artery diseases of the lower extremity 15,16 , however without investigating the interobserver agreement clinically. A previous in vitro study 14 revealed a good interobserver agreement for ACCmax (intraclass correlation coefficient of 0.99) and a good correlation between ACCmax and intra-arterial pressure gradient (R 2 0.937) was found.…”

“…8,[10][11][12][13] A relatively new velocimetric doppler-derived parameter, maximal systolic acceleration (ACCmax), has been evaluated in atherosclerotic diseases. [14][15][16][17][18][19][20] Recently we established in an in vitro study that a decreased ACCmax correlated very well with an increasing severity of stenosis, and a good correlation was found between the ACCmax and the intra-arterial pressure gradient (coefficient of determination (R 2 ) of 0.937). 14 A high ACCmax value endorses that there is no hemodynamic inflow problem and excludes the presence of peripheral artery disease.…”