Renal duplex sonography after treatment of renovascular disease

Abstract

To define the value of renal duplex sonography (RDS) to detect the presence of critical renal artery (RA) stenosis or occlusion after surgical repair or percutaneous transluminal balloon angioplasty (PTRA), we retrospectively reviewed our recent 71-month experience. Methods: From January 1987 through November 1992, 272 patients underwent 279 operative RA repairs and 35 patients underwent PTRA. Three hundred twenty-five RDS examinations were performed in 176 patients after operative intervention or PTRA during the study period. Forty-one of these patients had conventional angiography providing 61 RA for RDS comparison, and these data form the basis of this analysis. Twenty-four women and 17 men (mean age 57 years) underwent 44 operative RA repairs or 17 PTRA for correction of atherosclerotic disease (51 arteries) or fibromuscular dysplasia (10 arteries). Before their renovascular procedure each patient had significant hypertension (mean 193/106 mm Hg). RDS after surgery or PTRA was technically complete for all 61 RA. Results: Compared with angiography RDS correctly identified 47 of 48 repairs with less than 60% RA stenosis, 7 of 11 repairs with 60% to 99% stenosis, and 2 renal artery occlusions, providing a 69% sensitivity rate, 98% specificity rate, 90% positive predictive value, and a 92% negative predictive value. These results were adversely affected by branch RA disease, which accounted for three of four false-negative RDS study results. For 50 kidneys undergoing correction of main RA disease, RDS demonstrated an 89% sensitivity rate, 98% specificity rate, and 96% overall accuracy. RDS results were equivalent for both surgical and PTRA treatment. Conclusions: From this experience we conclude that RDS is useful for anatomic evaluation after surgical RA repair or PTRA. A negative RDS result excludes stenosis or occlusion of a main RA reconstruction but does not exclude significant branch level disease. (J VASC StTRG 1993;18:381-90.) Confirmation of the anatomic success of renal revascularization is assumed on the basis of a favorable blood pressure response in many centers. The fallacy of this assumption, however, has been documented repeatedly by previous reports. 1-3 Those recorded experiences have clearly documented that a favorable blood pressure response can occur after

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…These criteria have correlated with a stenosis exceeding 60% in most published series. Renal artery duplex ultrasonography is an excellent test to monitor renal artery patency after endovascular treatment or surgical revascularization of RAS (695,696). Unlike MRA, in which most stents currently cause artifacts, ultrasound transmission through a stent is not a problem.…”

Accuracy of duplex sonography scans after renal artery stenting

“…2 Moreover, RDS accurately defines patency, restenosis, and occlusion in followup after operative repair of RVD. 3 In addition to evaluation for clinical disease, RDS has defined the prevalence of RVD in a large, free-living group of elderly participants and defined the rate of anatomic progression in this group on follow-up. 4 Despite the value of RDS in screening, intraoperative assessment, and postoperative surveillance after open operative repair, recent studies have questioned the utility of RDS after percutaneous angioplasty and endoluminal stenting (PTAS) for RVD.…”

Early duplex predicts restenosis after renal artery angioplasty and stenting

“…Several authors have suggested that intraoperative duplex ultrasound completion studies and postprocedure surveillance are worthwhile after arterial interventions. 21,22,30 Normal duplex studies after arterial interventions confirm the absence of technical error, predict early clinical success, and establish a baseline for subsequent surveillance studies. Surveillance duplex ultrasound has found utility after carotid endarterectomy and stenting, 31 iliac stenting, 32 peripheral bypass and stenting, 33,34 as well as renal and mesenteric bypass and stenting.…”

“…Renal duplex sonography (RDS) has proven clinically useful as a screening method for native RA disease, 20 as an intraoperative completion study 21 and as a method to evaluate postoperative patency after open operative repair. 22 Recently, RDS parameters correlating with restenosis after RA-PTAS have also been defined. 23 This retrospective study examines the association between Doppler estimates of (RA) blood flow velocity from RDS performed within 1 week of RA-PTAS and restenosis during follow-up.…”