Follow-up of renal artery stenosis by duplex ultrasound

We have previously shown that duplex ultrasound is an accurate method of diagnosing renal artery stenosis (93% accuracy compared with angiography in the diagnosis of less than 60% stenosis, 60% to 99% stenosis, or occlusion). With this method we have now serially observed 35 renal arteries with 60% to 99% renal artery stenosis in 27 patients. Nineteen stenotic renal arteries in 15 patients were observed without intervention. There was a significant decrease in kidney size (mean difference - 1.0 cm; p less than 0.01; mean follow-up 13 months) but all 19 renal arteries remained patent. Percutaneous transluminal angioplasty (PTA) was performed in five patients (six renal arteries) for renovascular hypertension. Renal duplex scanning documented relief of renal artery stenosis in two patients whose hypertension improved after PTA and confirmed residual 60% to 99% renal artery stenosis in three patients whose hypertension did not improve after PTA (mean follow-up 6.5 months). Aortorenal bypass was performed for 10 stenotic renal arteries in seven patients. At a mean follow-up of 9 months duplex ultrasound documented eight patent and two occluded aortorenal bypass grafts. Duplex ultrasound is useful both for defining the natural history of untreated renal artery stenosis and assessing the results of renal artery angioplasty or bypass.