Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements.
Benny Drieghe,Juraj Madaric,Giovanna Sarno,Ganesh Manoharan,Jozef Bartunek,Guy R. Heyndrickx,Nico H.J. Pijls,Bernard De Bruyne +7 more
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TLDR
Generally accepted QRA and CDUS-derived indices of RAS severity overestimate the actual severity of R AS, which is likely the main cause of the disappointing results of renal angioplasty for renovascular hypertension.Abstract:
Aims A ratio of distal renal pressure to aortic pressure ( P d/ P a) <0.90 can be considered a threshold for defining a significant renal artery stenosis (RAS). The aim of this study was to compare renal angiography (QRA) and colour duplex ultrasound (CDUS) to pressure measurements in assessing RAS.
Methods and results In 56 RAS, percent diameter stenosis (DSangio), minimal luminal diameter (MLD), Doppler-derived peak systolic velocity (PSV), end-diastolic velocity (EDV), and renal-to-aortic ratio (RAR) were obtained and compared with the P d/ P a measured with a 0.014" pressure wire. P d/ P a correlated with angiography- and CDUS-derived parameters. The best correlation was observed with EDV ( R = −0.61). To identify stenosis associated with a P d/ P a 50%, MLD 180 cm/s, EDV > 90 cm/s and RAR > 3.5 were, respectively, 60%, 77%, 45%, 77% and 79%, yet, with a high proportion of false positives (38%, 15%, 55%, 11% and 15%, respectively) indicating an overestimation of the severity of the RAS by both QRA and CDUS. New cut-off values for QRA- and CDUS-derived indices were proposed.
Conclusion Generally accepted QRA and CDUS-derived indices of RAS severity overestimate the actual severity of RAS. This ‘overdiagnosis’ is likely the main cause of the disappointing results of renal angioplasty for renovascular hypertension.read more
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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) : Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries
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2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)
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References
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Journal ArticleDOI
Renal-Artery Stenosis
TL;DR: The goals for treating patients with RAS are to reduce cardiovascu-lar morbidity and mortality attributable to elevated arterial pressure and to preserve renal function beyond critical stenosis and to identify progressive occlusive disease and to determine appropriate timing for vascular intervention.
Journal ArticleDOI
Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis
Jörg Radermacher,Ajay Chavan,Jörg S. Bleck,Annabel Vitzthum,Birte Stoess,Michael Gebel,Michael Galanski,Karl M. Koch,Hermann Haller +8 more
TL;DR: A renal resistance-index value of at least 80 reliably identifies patients with renal-artery stenosis in whom angioplasty or surgery will not improve renal function, blood pressure, or kidney survival.
Journal ArticleDOI
The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis.
Jeffrey W. Olin,Marion R. Piedmonte,Jess R. Young,Susan DeAnna,Michael W. Grubb,Mary Beth Childs +5 more
TL;DR: The utility of duplex ultrasound scanning of the renal arteries is determined for identifying patients with renal artery stenosis of 60% or more and for excluding patients with either normal renal arteries or renal arteriography of less than 60%.
Journal ArticleDOI
Renal duplex sonography : evaluation of clinical utility
Kimberley J. Hansen,Reid W. Tribble,Scott W. Reavis,Vincent J. Canzanello,Timothy E. Craven,George W. Plonk,Richard H. Dean +6 more
TL;DR: It is concluded that renal duplex sonography can be a valuable screening test in the search for correctable renovascular disease causing global renal ischemia and secondary renal insufficiency (ischemic nephropathy) nor does it predict hypertension or renal function response after correction of renov vascular disease.
Journal ArticleDOI
Guidelines for the Reporting of Renal Artery Revascularization in Clinical Trials
John H. Rundback,David Sacks,K. Craig Kent,Christopher J. Cooper,Daniel Jones,Timothy P. Murphy,Kenneth Rosenfield,Christopher J. White,Michael A. Bettmann,Stanley Cortell,Jules B. Puschett,Daniel G. Clair,Patricia E. Cole +12 more
TL;DR: This document provides guidelines and definitions for the design, conduct, evaluation, and reporting of renal artery revascularization RCTs, and areas of critically necessary renal arteryRevascularization investigation are identified.
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