9 patients received the angiography found 10 renal arterial stenosid or obstruction among 100 patients during 1/1995 - 3/1998. The results showed that the level of the arterial stenosid by ultrasound was quite suitable with this by the angiography. All patients received an operation for connecting the renal artery or thrombosis removal were postoperative examined by the color ultrasound Doppler and long-term monitored.
Ultrasonography ; Renal Artery Obstruction

Nowadays, diagnosis of renal artery stenosis by renal angiography is gradually supplied by techniques of noninterference, include: Colour Doppler ultrasound, CT angiography in helical with MIP, magnetic resonance angiography. In the all, the colour Doppler ultrasound is the best method for diagnosis of renal artery atenosis in the near future
Ultrasonography ; Renal Artery Obstruction

The study was conducted from January 1996 to March 1998 in B¹ch Mai Hospital. Participants were 100 hypertensive patients who have suspected renal artery stenosis after screening using clinical examination. Age of participants ranged from 9 to 50. All participants underwent colour ultrasonography and measurements are evaluated. Results showed that among 18 renal arteries of 9 patients, who received ultrasonography and angiography, 10 arteries were stenosed or occluded. 1 renal artery had suspected stenosis showed in ultrasonography, but not in angiography. So Doppler ultrasonography produced 1 false positive result, 10 true positive results, 7 true negative results and none false negative. This procedure gave high 100% of sensivity, 87.5% of speciality, positive prediction value is 90.9%, negative prediction value is 100%. Doppler ultrasonography can be used for post-operative examination and for patient following-up
Renal Artery Obstruction ; Ultrasonography

In stenosis of a segmental branch or among multiple renal arteries, Doppler sampling of intrarenal arteries in the upper, mid and lower poles demonstrates strikingly different waveform patterns that might otherwise be overlooked. We report a case of segmental branch renal artery stenosis in which a pulsus parvus et tardus waveform was observed in a segmental branch of a renal artery. In this case, systematic analysis of Doppler waveforms of intrarenal arteries at more than three different locations facilitated a rapid and confident diagnosis of seg-mental branch renal artery stenosis.
Adult ; Case Report ; Female ; Human ; Renal Artery/ultrasonography ; Renal Artery Obstruction/*ultrasonography ; Support, Non-U.S. Gov't ; *Ultrasonography, Doppler

BACKGROUNDSome individuals have multiple renal arteries. Severe stenosis in one of the arteries may cause refractory hypertension. The detection of stenosis within one of the multiple renal arteries usually required invasive procedures, such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). This study reported the application of color Doppler sonography (CDS) in the detection of severe stenosis in one of the multiple arteries.

METHODSPatients with multiple renal arteries and one of the arteries with severe stenosis were retrospectively studied. Peak systolic velocities (PSV) of renal arteries and the intrarenal CDS patterns were collected and compared. The diagnosis was confirmed by digital subtraction angiography (DSA).

RESULTSFour children with multiple renal arteries and one of the arteries with stenosis were investigated. They were admitted due to refractory hypertension. CDS screening identified two renal arteries in one kidney of each patient with one of the two renal arteries having stenosis > 70%. The PSV of the stenosed arteries were much higher, and the intrarenal CDS patterns supplied by the stenosed arteries changed into T-P patterns.

CONCLUSIONNon-invasive CDS technology may be a useful method to identify severe stenosis in one of multiple renal arteries in young patients.

Adolescent ; Child ; Female ; Humans ; Male ; Renal Artery ; abnormalities ; Renal Artery Obstruction ; diagnostic imaging ; Ultrasonography, Doppler, Color ; methods

Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.
Adolescent ; Angiography ; Angioplasty ; Antihypertensive Agents ; Blood Pressure ; Child ; Fibromuscular Dysplasia ; Humans ; Hypertension ; Hypertension, Renovascular ; Kidney ; Nephrectomy ; Renal Artery ; Renal Artery Obstruction ; Stents ; Ultrasonography, Doppler

PURPOSE: Transplant renal artery stenosis (TRAS) is a potentially treatable complication of kidney transplantation. Color doppler ultrasound (doppler US) is recommended as primary diagnostic method, but it has some limitations. METHODS: We analyzed with 3D computed tomography angiography (3D-CTA) compared doppler US in the diagnosis of TRAS. Eleven transplant recipients (4 women, 7 men) with new developed or uncontrolled hypertension underwent 3D-CTA. We compared 3D-CTA with the dopper US in all TRAS recipients diagnosed 3D-CTA (n=6). RESULTS: The median age at transplantation was 42 year (Range: 27~55 year), mean systolic blood pressure +/-SD was 163+/-9.9 mmHg and median HLA mismatch was 2 (0~4). The 3D-CTA showed significant TRAS (>70% luminal narrowing) in six recipients. Most commonly stenosis occurred at the anastomotic site (anastomic site, 4; pre-anastomotic 1; diffuse 1 recipients). The dopper US showed suspected TRAS in four recipients but no evidence of TRAS in two recipients. But these all patients showed significant stenosis (>70% luminal narrowing) of transplant renal artery by the percutaneous angiography. All six TRAS recipients successfully were treated by primary percutaneous angioplasty and endovascular stenting. Arterial blood pressure showed significantly improvement after post-endovascualr therapy (Presystolic, 170+/-8 mmHg; postsystolic, 151+/-16 mmHg; P=0.012 and prediastolic, 104+/-4; postdiastolic 92+/-8; P=0.007). CONCLUSION: The 3D-CTA is highly accurate and noninvasive screening test for detecting TRAS than dopper US.
Angiography ; Angioplasty ; Arterial Pressure ; Blood Pressure ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Hypertension ; Kidney Transplantation ; Mass Screening ; Phenobarbital ; Renal Artery Obstruction* ; Renal Artery* ; Stents ; Transplantation ; Ultrasonography

OBJECTIVETo analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis.

METHODSClinical data of 9 patients underwent endovascular therapy due to moderate renal artery stenosis (50%-69%) in Anzhen hospital from May to September 2013 were retrospectively analyzed. Fractional flow reserve (FFR) were measured in patients with moderate stenosis in renal artery and abnormal glomerular filtration rate (GFR) or different between renal artery angiography and ultrasound before the procedure. Endovascular therapy was not applied for patients with FFR > 0.90, and the patients were subsequently followed up clinically. Endovascular therapy was applied in patients with FFR less than 0.90 or the pressure difference between the two ends of stenosis was more than 20 mmHg (1 mmHg = 0.133 kPa). Blood pressure, ultrasound and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively.

RESULTSThere were 6 patients diagnosed as severe renal artery stenosis (≥ 70%) and the other 3 patients diagnosed as moderate renal artery stenosis by renal artery ultrasound before operation. Two patients with FFR > 0.90 were not undertaken the endovascular therapy. Seven patients with FFR < 0.90 underwent endovascular therapy. After renal artery stenting, renal stenosis was relieved immediately and the transstent blood flow was fluency in these 7 patients. There was significant difference in the FFR before and after operation (0.81 ± 0.09 vs.0.94 ± 0.03, P = 0.008). Among the patients underwent endovascular therapy, blood pressure was normal without medication in 2 patients and well controlled with 1 or 2 combined antihypertensive drugs in the rest 5 patients.

CONCLUSIONIn patients with moderate renal artery stenosis, fractional flow reserve measurement could be used as a useful index to guide intervention procedure and to evaluate the efficacy of endovascular therapy.

Angiography ; Constriction, Pathologic ; therapy ; Fractional Flow Reserve, Myocardial ; Hemodynamics ; Humans ; Renal Artery ; diagnostic imaging ; Renal Artery Obstruction ; therapy ; Retrospective Studies ; Stents ; Ultrasonography

PURPOSE: Splenorenal bypass is a major surgical procedure that's used for the management of renal artery stenosis. Herein, we evaluate the feasibility and efficacy of performing laparoscopic splenorenal bypass in a chronic canine model. MATERIALS AND METHODS: A total of 12 animals were used for this study. The initial 6 acute animals were used to develop the technique. The remaining 6 surviving animals, which form the basis for this report, were used for a chronic study with up to 2 months follow-up. The renal artery and the distal splenic artery was dissected, its proximal end clamped and its distal end cut and spatulated. An end-to-end anastomosis of the splenic artery and renal artery was performed using only laparoscopic freehand suturing and knot-tying techniques. Upon revascularization, a laparoscopic doppler ultrasound probe was used to document blood flow in the renal artery. Three animals were each followed for 1 month and 2 months, respectively. RESULTS: The total operative time was 297+/-36 min. The mean number of suture bites per anastomosis was 14.3. The only intraoperative complication was hemorrhage from the anastomotic site. Intraoperative Doppler ultrasound documented good blood flow in all 6 animals upon releasing the clamp. At the time of euthanasia, intravenous pyelography (IVP) showed early visualization of the left kidney with prompt drainage in 5 of the 6 surviving animals. In one animal that had two left renal arteries, a distal thrombosis was found despite the patent anastomotic site. CONCLUSIONS: Laparoscopic splenorenal bypass can be performed in a reproducible fashion with using only intracorporeal techniques. We believe that with experience, complex urologic vascular procedures can be laparoscopically performed in the future.
Animals ; Drainage ; Euthanasia ; Follow-Up Studies ; Hemorrhage ; Intraoperative Complications ; Kidney ; Laparoscopy ; Models, Animal ; Operative Time ; Renal Artery ; Renal Artery Obstruction ; Splenic Artery ; Splenorenal Shunt, Surgical* ; Sutures ; Thrombosis ; Ultrasonography ; Urography

Aged ; Angiography ; Angioplasty, Balloon ; methods ; Atherosclerosis ; complications ; Drug-Eluting Stents ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Renal Artery Obstruction ; diagnostic imaging ; etiology ; therapy ; Treatment Outcome ; Ultrasonography