Digital subtraction arteriography in the diagnosis of renovascular hypertension

Renal digital subtraction arteriography (RDSA) is a relatively safe, simple, and inexpensive means of detecting the presence of renovascular disease in hypertensive patients. We report our own 15-month experience with RDSA, performed on 166 patients because of hypertension, and review the literature. Twenty-eight of the patients had arteriography. Using this as a measure, the sensitivity of RDSA was 83% and its specificity 96%. RDSA findings are usually conclusive. Addition of plain films following the procedure permits evaluation of renal parenchyma, collecting systems, ureters, and bladder. Arteriography should be reserved for those patients with positive RDSA to be treated by surgery or angioplasty, and for the small number of patients who have a non-diagnostic RDSA. If renal vein renin sampling is done first, RDSA may be performed at the same time. As RDSA becomes more available there will be little place for rapid sequence urography in the investigation of hypertension. In patients suspected of having renovascular hypertension, the primary mode of investigation should be renal DSA.