Journal of Vascular Surgery

2009

DOI: 10.1016/j.jvs.2008.08.008

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Clinical utility of the resistive index in atherosclerotic renovascular disease

Teresa A. Crutchley

¹

,

Jeffrey D. Pearce

²

,

Timothy E. Craven

³

et al.

Abstract: After intervention for AS-RVD, RI was associated with renal function, but not blood pressure response. A strong, independent relationship between RI and mortality was observed for all patients and both treatment groups.

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Introduction2

Distal Criteria (Indirect Evaluation Of the Stenosis)1

Prognostic Significance Of the Rri1

Differences To Existing Methods Of Sonographic Perfusion Eva1

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Cited by 59 publications

(43 citation statements)

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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: 98%

Doppler ultrasound and renal artery stenosis: An overview

¹

,

³

et al. 2009

Journal of Ultrasound

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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...

“…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: 98%

Doppler ultrasound and renal artery stenosis: An overview

¹

,

³

et al. 2009

Journal of Ultrasound

View full text Add to dashboard Cite

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...

“…The RRI has been studied and used widely to gain diagnostic and prognostic insights into a variety of renal clinical conditions such as renal allograft rejection [2,3], renal artery stenosis in hypertensive patients [4,5], progression of chronic kidney disease [6] and renal and composite adverse outcomes in critically ill patients [7,8]. …”

Section: Prognostic Significance Of the Rrimentioning

confidence: 99%

“…1) [1]. Over the last years, the RRI has been studied intensively to gain diagnostic and prognostic insights into a variety of renal clinical conditions such as assessment of renal allograft rejection [2,3], detection and management of renal artery stenosis in hypertensive patients [4,5], evaluation of progression in chronic kidney disease [6] and prediction of renal and composite adverse outcomes in critically ill patients [7,8]. Although the RRI was initially considered to reflect only intrarenal vascular pathological processes, this index is actually a product of a complex interaction between renal and systemic vascular wall properties and hemodynamic factors, yet most of these factors are insufficiently understood [1].…”

Section: Introductionmentioning

confidence: 99%

Determinants and Prognostic Significance of the Renal Resistive Index

Cauwenberghs¹,

2015

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Background: The noninvasive assessment of renal hemodynamics is currently possible by assessing the renal resistive index (RRI) derived from intrarenal Doppler arterial waveforms as (peak systolic velocity - end-diastolic velocity)/peak systolic velocity. In this review, we outline the important determinants of the RRI to clarify the true identity of the RRI and highlight its potential diagnostic and prognostic value in renal and cardiovascular pathology. Summary: Although the RRI was initially considered to reflect intrarenal vascular pathological processes, this index is actually a product of a complex interaction between renal and systemic vascular wall properties and hemodynamic factors. Indeed, studies in patients and general populations consistently demonstrated a significant and direct association between the RRI and central or peripheral pulse pressure independent of other covariables. Moreover, studies in renal transplant patients also showed that the RRI mainly reflects characteristics of the recipient but not those of the graft. Thus, the major influence of the systemic hemodynamics on the intrarenal arterial waveforms excludes RRI as a specific marker of renal vascular pathology. On the other hand, because the RRI reflects pulsatility in renal arteries, it might be useful for the early detection of renal microvascular damage. Future longitudinal studies are still needed to clarify whether the detection of Doppler changes in intrarenal arteries might yield an improvement in the adverse cardiovascular and renal outcome. Conclusion: Published studies on RRI imply that the interaction between the systemic hemodynamics and peripheral circulation in the kidney is a complex physiological phenomenon. In addition to renal vascular properties, the central hemodynamic factors significantly influence the intrarenal arterial Doppler waveform patterns. Previous research also suggested an important role of the RRI for the evaluation of renal target organ damage, particularly in patients with increased pulsatility of the intrarenal blood flow.

“…Today RI and PI calculations are the most widely used techniques to quantify flow velocity changes [4][5][6][7][8][9][10]. They do not allow conclusions as for the perfusion intensity or volume since the perfused area of the vessel under investigation is not included in the calculation.…”

Section: Differences To Existing Methods Of Sonographic Perfusion Evamentioning

confidence: 99%

Dynamic Tissue Perfusion Measurement – Basics and Applications

2012

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