Accuracy of colour duplex sonography for the diagnosis of renal artery stenosis

Saeed, Aso; Bergström, Göran; Zachrisson, Karin; Guron, Gregor; Nowakowska-Fortuna, Elzbieta; Fredriksen, Ellen; Lönn, Lars; Jensen, Gert; Herlitz, Hans

doi:10.1097/hjh.0b013e32832c417d

Cited by 20 publications

(19 citation statements)

References 17 publications

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“…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).…”

Section: Discussionsupporting

confidence: 68%

“…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.…”

mentioning

confidence: 99%

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

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

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Background: Because of the presence of medial calcific sclerosis, both ankle-branchial index and toe pressure measures can yield misleading results when attempting to diagnose peripheral artery disease (PAD). A new ultrasound parameter, maximal systolic acceleration (ACC max ), can be an accurate tool for diagnosing PAD, including in diabetic patients. However, it has not been evaluated thoroughly. The aim of this study was to assess the feasibility of using ACC max to diagnose and assess the severity of PAD.Methods: The human circulatory system was simulated using an in vitro circulatory system driven by a pulsatile pneumatic pump. Arterial stenosis of various degrees (50%, 70%, 80%, and 90%) was simulated in order to investigate the change in several ultrasound parameters (including ACC max ), as well as the intraluminal mean arterial pressure gradient. In a separate set of measurements, interobserver variability was measured using two investigators who were unaware of the degree of stenosis.Results: ACC max significantly decreased (P < .001), and the pressure gradient increased (P < .001) as the degree of stenosis increased. Moreover, we found a strong correlation between ACC max and the pressure gradient (R 2 ¼ 0.937). Finally, interobserver variability with respect to ACC max was extremely low, with an intraclass correlation coefficient of 0.99. Conclusions:The results of this flow model study suggest that ACC max can be a valid, noninvasive tool for diagnosing PAD. Moreover, our finding that ACC max decreases as the severity of stenosis increases, together with the strong correlation between ACC max and the pressure gradient, suggests that ACC max may be useful as an alternative diagnostic tool for assessing the severity of PAD. These promising in vitro data warrant further study in a clinical setting. (J Vasc Surg 2020;71:242-9.)Clinical Relevance: Limb pressure measurements and the determination of pressure index values (ankle-branchial index and toe pressure) are commonly used in patients with symptoms consistent with peripheral arterial disease. However, ankle-branchial index and toe pressure can be falsely elevated or falsely normal due to medial calcific sclerosis. In this in vitro flow-model study, the maximal systolic acceleration (ACC max ) significantly decreased as the degree of stenosis increased. Furthermore, there was a strong correlation between ACC max and the intraluminal pressure gradient. These results suggest ACC max may provide a robust noninvasive technique for assessing the severity of peripheral arterial disease.

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Section: Discussionsupporting

confidence: 68%

mentioning

confidence: 99%

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

Brouwers

Doorn

Wissen

et al. 2020

Journal of Vascular Surgery

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“…Such variables may explain why some authors have not been able to reproduce these results [30,35]. Therefore, these criteria are used only when obvious on spectral traces, when quantifying the stenosis as severe (> 75%), or when identifying a downstream pattern of a stenosis on a segmental or an accessory artery that has been missed [28,36]. Most accrediting organizations recommend the use of a combination of intraand extrarenal parameters, as it results in an overall sensitivity of 89% and specificity of 92% [11,37].…”

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

102

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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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“…Renal artery aneurysms were identified in four of 716 (0AE6%) potential kidney donors, all four presenting with lesions suggestive of FMD; furthermore, 12 of 125 (9AE6%) patients with symptomatic renal artery FMD also had renal artery aneurysms [17] and Brussels [18]. [1].…”

Section: Screening For Intracranial Aneurysmsmentioning

confidence: 99%

“…Several studies suggest that echo-Doppler velocimetric indexes, particularly acceleration time, may reliably predict the existence of a significant stenosis [17,18]. However, these studies included only few patients with FMD.…”

Section: Diagnosis Of Significant Stenosismentioning

confidence: 99%