What is the relevance of systematic aorto-femoral Doppler ultrasound in the preoperative assessment of patients awaiting first kidney transplantation: a monocentric prospective study.
BACKGROUND
The purpose of our study was to study the relevance of a systematic aorto-femoral colour Doppler ultrasound (DUS) in the evaluation of first renal transplant receivers.


METHODS
We prospectively studied 100 consecutive first renal transplant (RT) receivers. All patients had a preoperative physical examination with a careful vascular system evaluation including assessment of risk factors and colour DUS of aortic, iliac and femoral arteries. Renal transplantation was planned in the right iliac fossa with end-to-lateral vascular anastomoses. Clinical parameters, DUS results, operative and post-operative parameters at 3 months were compared according to the vascular assessment.


RESULTS
Among the 84 patients presenting with a normal preoperative physical arterial examination, 12 patients (14.3%) had an abnormal DUS, revealing atherosclerotic arteries, but no case of arterial stenosis. Among the 16 patients with abnormal physical arterial examination, 10 patients (62.5%) had abnormal DUS, including 4 cases of iliac stenosis. In 3 of the 16 patients (18.8%), DUS revealed right iliac artery stenosis requiring a modification in the surgical procedure. No additional vascular procedure was reported in the case of normal preoperative vascular examination. No technical problems during arterial anastomosis and no post-transplantation arterial complications were reported. In multivariate analysis, abnormal physical examination was the most significant risk factor of atherosclerotic infiltration in DUS.


CONCLUSIONS
The abnormality of arterial physical examination is the best clinical predictor of abnormal DUS in preoperative assessment of renal transplant receivers. However, the low sensitivity and positive predictive value of the physical examination do not support the conclusion that DUS can be avoided in patients with normal arterial physical examination. Nevertheless, in the case of arterial physical abnormality, 'for case' DUS is critical and helps in the surgical strategy in approximately 20% of cases.
Ploussard
Guillaume
G
Department of Urology and Paris 7 University, Saint Louis Hospital, Paris, France.
Mongiat-Artus
Pierre
P
Meria
Paul
P
Tariel
Edouard
E
Gaudez
François
F
De Kerviler
Eric
E
Legendre
Christophe
C
Peraldi
Marie-Noelle
MN
Glotz
Denis
D
Desgrandchamps
François
F
D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010808:Physical Examination; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color