Color duplex sonography in severe transplant renal artery stenosis: a comparison of end-to-end and end-to-side arterial anastomoses.
OBJECTIVE
The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS, arterial lumen reduction >80%) with end-to-end (EE) arterial anastomosis and that with end-to-side (ES) arterial anastomosis.


METHODS
We retrospectively reviewed color duplex sonography (CDUS) and digital subtraction angiography (DSA) images in 38 patients with severe TRAS (19 cases with EE and 19 cases with ES) between January 1, 2000, and December 31, 2006. Doppler parameters were analyzed, including peak systolic velocity (PSV) in the iliac artery, PSV at the arterial anastomosis, PSV in the transplant renal artery, PSV ratio of the stenotic artery/artery proximal to the stenosis, and acceleration time (AT) in the artery distal to the stenosis (in the intrarenal artery). All 38 cases with severe TRAS were initially diagnosed with CDUS and confirmed by DSA.


RESULTS
There were significant differences in PSV in the stenotic artery (P<.01), PSV in the iliac artery (P<.001), and PSV ratios of stenotic artery/artery proximal to the stenosis (P<.001) between arterial anastomosis of EE and that of ES. There was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis (P>.05).


CONCLUSIONS
Significantly different PSVs in the stenotic artery, the iliac artery, and the PSV ratio between EE and ES arterial anastomoses should be considered in the interpretation of CDUS when screening for severe TRAS. Different criteria of CDUS need to be established depending on the type of arterial anastomosis in order to improve the accuracy in diagnosing severe TRAS.
Gao
Jing
J
Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA. jig2001@med.cornell.edu
Li
Jian-Chu
JC
Xiao
Meng-Su
MS
Ng
Amelia
A
Trost
David
D
Goldstein
Michael
M
Kapur
Sandip
S
Wang
John
J
Serur
David
D
Dai
Qing
Q
Jiang
Yu-Xin
YX
Min
Robert J
RJ
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology; D007083:Iliac Artery / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult