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Fibromuscular dysplasia in living renal donors: still a challenge to computed tomographic angiography
D Blondin1, R Lanzman, F Schellhammer
1Institute of Radiology, University Hospital Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf, Germany. blondin@med.uni-duesseldorf.de
Insights
Computed tomographic angiography (CTA) accurately detects significant vascular issues in living renal donors. However, mild fibromuscular dysplasia may be missed, necessitating further investigation in select cases.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Computed tomographic angiography (CTA) is the standard for evaluating living renal donors.
- Fibromuscular dysplasia (FMD), though rare, impacts renal transplant success.
- Assessing FMD incidence and CTA reliability in living renal donors is crucial.
Purpose of the Study:
- Determine the incidence of fibromuscular dysplasia (FMD) in living renal donors.
- Evaluate the reliability of computed tomographic angiography (CTA) in detecting vascular pathologies in this population.
Main Methods:
- Retrospective analysis of 101 living renal donors evaluated by CTA between 7/2004 and 9/2008.
- CTA examinations performed using a 64 Multi-detector CT scanner.
- Assessment of FMD signs (string-of-beads, stenosis, aneurysms), vascular anatomy, and arterial stenosis; comparison with operative and histological reports.
Main Results:
- Four cases (3.9%) of fibromuscular dysplasia (FMD) were diagnosed in 101 donors.
- CTA detected three FMD cases; one mild case was missed on retrospective CTA review.
- CTA identified other vascular anomalies: 10 accessory arteries, 14 venous anomalies, and 12 atherosclerotic renal artery stenoses.
Conclusions:
- CTA is effective for detecting hemodynamically significant stenosis and assessing vascular anatomy in living renal donors.
- CTA may underestimate mild fibromuscular dysplasia (FMD).
- Further diagnostic workup, potentially including digital subtraction angiography (DSA), may be needed for subtle vascular irregularities not typical of atherosclerosis.
Background:
Computed tomographic angiography has become the standard evaluating method of potential living renal donors in most centers. Although incidence of fibromuscular dysplasia is low (3.5-6%), this pathology may be relevant for success of renal transplantation. The incidence of FMD in our population of LRD and reliability of CTA for detecting vascular pathology were the aims of this study.
Materials And Methods:
101 living renal donors, examined between 7/2004 and 9/2008 by CTA, were included in a retrospective evaluation. The examinations were carried out using a 64 Multi-detector CT (Siemens Medical Solutions, Erlangen). The presence or absence of the characteristic signs of fibromuscular dysplasia, as "string-of-beads" appearance, focal stenosis or aneurysms, were assessed and graded from mild (=1) to severe (=3). Furthermore, vascular anatomy and arterial stenosis were investigated in this study. Retrospective analysis of CTA and ultrasound were compared with operative and histological reports.
Results:
Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report.
Conclusion:
CTA is sufficient for detection of hemodynamic relevant stenosis and vascular anatomy. Only one patient with a mild form of FMD was under estimated. Therefore, if the CTA shows slightest irregularities which are not typical for atherosclerotic lesions, further diagnostic work up by DSA might still be necessary.
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