title: Duplex ultrasound findings before and after surgery in children and adolescents with renovascular hypertension.
abstract: We report our experience with duplex ultrasound in young patients with renal artery stenosis (RAS) or middle aortic syndrome (MAS) before and after surgery (1995 and 2009). Of 36 patients (mean age: 13 ± 7 y), 21 had RAS and 15 had MAS. For patients with RAS, the Vmax in the affected artery was 350 ± 111 cm/s before surgery and 145 ± 55 cm/s after surgery. The resistance index was 0.46 ± 0.1 in the post-stenotic kidney and increased to 0.60 ± 0.08 after revascularization. Determination of the flow profile in the iliac artery revealed triphasic flow. In individuals with MAS, Vmax in the aorta was 323 ± 98 and the resistance index in both kidneys was low, even in the absence of RAS. The flow profile in the iliac arteries was monophasic before surgery and became triphasic after surgery. Duplex ultrasound is useful for the evaluation of children and young adults both pre- and post-surgery. Duplex ultrasound criteria for RAS in adults appear to be applicable in children and young adults also. The diagnostic evaluation of suspected renal vascular disease should include assessment of the aorta and the flow profile in the iliac arteries, as this could help differentiate between aortic and isolated renal artery stenosis.
authors.affiliation: Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany. Electronic address: avoiculescu@partners.org.
authors.forename: Adina
authors.initials: A
authors.lastname: Voiculescu
authors.affiliation: Paediatric Cardiology and Pulmonary Medicine, Helios Klinikum Wuppertal, Wuppertal, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Heusch
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Düppers
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Siamak
authors.initials: S
authors.lastname: Pourhassan
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Klee
authors.affiliation: Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Lars C
authors.initials: LC
authors.lastname: Rump
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D055815:Young Adult
keywords: Abdominal aortic coarctation; Diagnostic tests; Doppler; Mid-aortic syndrome; Renal artery stenosis; Renovascular hypertension