Duplex ultrasound scanning in the diagnosis of renal artery stenosis: A prospective evaluation

Abstract

Since ultrasonic energy can be used to interrogate vessels at great depth, it is only natural that it should be applied to deeply placed arteries in the abdomen. Early studies suggested that high-grade stenoses of the renal artery could be detected by this approach as long as the peak systolic velocity in the renal artery was normalized by that measured in the abdominal aorta. A retrospective study comparing the peak velocity in the renal artery to that from the adjacent abdominal aorta (the renal aortic ratio) showed that if this value exceeded 3.5, it is likely to be associated with a greater than 60% diameter-reducing stenosis. To test this hypothesis, we used duplex scanning to prospectively evaluate 58 renal arteries in 29 patients in whom arteriograms were available. There were 39 renal arteries with 0% to 59% stenosis, 14 with 60% to 99% stenosis, and five occlusions by angiography. Renal duplex scanning accurately diagnosed 38 of 39, 11 of 14, and four of five of these, respectively, giving a sensitivity of 84%, a specificity of 97%, and a positive predictive value of 94% for the detection of a greater than 60% diameter-reducing stenosis. The overall agreement with angiography was 93%. These data show that renal duplex scanning can be used to diagnose renal artery stenosis in patients with hypertension or renal dysfunction, thus providing a rational basis for the selection of patients for angiography.

Reno-vascular hypertension in childhood: a nationwide survey

“…Although the sensitivity of Doppler ultrasonography in renal artery stenosis was reported to be between 84% and 100%, stenosis could be detected in 68% of our patients by this method [23][24][25]. The main limiting factors of Doppler ultrasonography for detecting renal artery stenosis may be non-cooperation and bowel gas interposition in children.…”

ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients

“…Duplex (Doppler with B-mode) ultrasound, compared with angiography, has a sensitivity of 84% to 98% and a specificity of 62% to 99% for detecting RAS (687)(688)(689)(690)(691)(692)(693). An enddiastolic velocity of more than 150 cm per second predicts severe (greater than 80%) RAS (694).…”

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

“…However, it is not without risk; these procedures are associated in up to 50% of the cases with a temporary or permanent reduction in glomerular filtration rate that may relate either to contrast nephropathy (both iodine-based and more recently gadolinium-associated) [12] or to cholesterol embolization [13]. Renal artery duplex scanning can be performed with high levels of accuracy and reproducibility in patients with ARAS [14,15,16,17,18]. Additional advantages include being noninvasive and less expensive than intra-arterial digital subtraction angiography.…”