Colour Doppler ultrasound in the diagnosis of transplant renal artery stenosis.
The validity of colour Doppler ultrasound (CDU) in the detection of transplant renal artery stenosis (TRAS) was investigated. 93 patients presenting with deteriorating hypertension underwent CDU. Seven out of 93 patients (8%) were excluded from the study because of incomplete visualization of the transplant vessels. The CDU diagnosis of TRAS was made when all of the following criteria were present: 1. local increase in flow velocity exceeding 150% of the values found in other sections of the transplant artery and 2. marked turbulences in the artery distally of a region with local flow increase. 86 CDU examinations obtained in 86 patients [52 male, 34 female; mean age 45.7 +/- 12.6 years; examined on average 28.8 months (1-156) after transplantation] were compared with 40 angiographies. Patients showing stenosis in the CDU (n = 12) or receiving combined antihypertensive therapy with 3 or more drugs (n = 28) had an angiography performed. Angiography confirmed 11 out of the 12 arterial stenoses that had been found with CDU and detected one segment artery stenosis of 30-50% that was not detected by CDU. In 4 stenosed arteries, peak velocities were higher than the maximum velocity measurable with the pw-Doppler (higher than 350 cm/s). Peak velocities measured by CDU within 8 stenoses exceeded the flow speeds obtained elsewhere in the artery by 193 +/- 35% (286 +/- 82 cm/s). Using the criteria of stenosis as defined in this paper, CDU may be employed as screening method to detect TRAS with a sensitivity of 92% and a specificity of 96%.
Medizinische Klinik und Poliklinik, Heinrich-Heine-Universität Düsseldorf.
M
M
Hollenbeck
B
B
Kutkuhn
B
B
Grabensee
D000328:Adult; D000714:Anastomosis, Surgical; D000792:Angiography; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000188:drug therapy; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000188:drug therapy; D018615:Ultrasonography, Doppler, Color / Q000187:drug effects
D000959:Antihypertensive Agents