A case of reocclusion of the renal artery diagnosed by the color Doppler method with evaluation of blood flow direction in the collateral circulation of the kidney in addition to the non-detectable blood signal in the renal artery.
A 23-year-old woman was referred to our hospital for an interventional procedure for chronic total occlusion of the right renal artery, probably due to fibromuscular dysplasia (FMD), and for control of renal vascular hypertension. Before percutaneous transluminal renal angioplasty (PTRA), aortography revealed collateral circulation to the right kidney from the lower lumbar artery. After PTRA, however, blood flow in the renal side of the collateral circulation flowed outside from the right renal parenchyma. 4 months later, we could not find a blood flow signal in the right renal artery, and there was a contrary flow signal in the right kidney parenchyma continuously from the extrahilar vessel, possibly a collateral artery. These findings indicated reocclusion of the right artery. We confirmed reocclusion of the renal artery and collateral feeding by contrast dynamic computed tomography (CT), and PTRA was performed again without any complications or reocclusion for 5 months. This is the first case report showing that a back-flowing signal in the right renal parenchyma from the extrahilar artery is useful as an indirect finding suggesting reocclusion.
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan. megu_s@jikei.ac.jp.
Megumi
M
Hirano
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Tomoyuki
T
Ohta
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Norio
N
Nakata
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Reina
R
Kawakami
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Kimihiro
K
Takamura
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Tosiharu
T
Matsuda
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Makiko
M
Nishioka
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Tomoo
T
Sakurai
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Kouichi
K
Matsuo
Department of Radiology, Diagnostic Ultrasonographic Center, Jikei University School of Medicine Hospital, Tokyo, Japan.
Yukio
Y
Miyamoto
D001027:Aortography; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging*; D012039:Regional Blood Flow; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000502:physiology / Q000601:surgery; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
Collateral circulation; Color Doppler; Renal artery; Ultrasonography