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Echo-Doppler diagnosis of renal allograft artery stenosis
J W Merkus1, A J Hoitsma, W N van Asten
1Department of Surgery, University Hospital St Radboud Nijmegen, The Netherlands.
Insights
Echo-Doppler is a reliable, noninvasive method for diagnosing renal allograft artery stenosis in hypertensive transplant recipients. Quantitative Doppler analysis improves diagnostic accuracy compared to invasive angiography.
Area of Science:
- Nephrology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Renal transplant recipients with hypertension are at risk for allograft artery stenosis.
- Noninvasive diagnostic methods are preferred over invasive angiography.
- Echo-Doppler ultrasound is a potential noninvasive tool for evaluating renal allograft artery stenosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of echo-Doppler for renal allograft artery stenosis.
- To compare echo-Doppler findings with angiography in hypertensive renal transplant recipients.
- To identify quantitative Doppler criteria for reliable stenosis detection.
Main Methods:
- 131 hypertensive renal transplant recipients underwent echo-Doppler examinations.
- Measurements of stenosis indicators and quantitative analysis of intrarenal Doppler spectra were performed.
- Angiography was used as a gold standard in a subset of patients for comparison.
Main Results:
- Echo-Doppler suspected renal allograft artery stenosis in 12 patients; angiography confirmed stenosis in all 8 who underwent the procedure (6 with >75% stenosis).
- In 8 patients with normal echo-Doppler, angiography revealed no stenosis or only 50% stenosis in one.
- Significant differences in Doppler parameters were observed between patients with and without severe stenosis (>75%).
Conclusions:
- Echo-Doppler examinations, particularly with quantitative Doppler spectral analysis, are reliable for identifying renal allograft artery stenosis.
- This noninvasive approach offers a preferable alternative to angiography for diagnosing stenosis in this patient population.
- Quantitative Doppler criteria can effectively differentiate between severe and non-severe allograft artery stenosis.
Abstract:
For the diagnosis of allograft artery stenosis in recipients of a renal transplant with hypertension a noninvasive investigation such as echo-Doppler is preferable to invasive methods such as angiography. Therefore we analyzed our experience with echo-Doppler diagnosis of renal allograft artery stenosis. In 131 renal transplant recipients with hypertension echo-Doppler examinations were performed. During the examinations several features indicative of stenosis were measured, and intrarenal Doppler spectra were quantitatively analyzed with a user-written program. Four patients showed signs of iliac artery stenosis. In 12 patients a renal allograft artery stenosis was suspected on echo-Doppler examination. In 8 of these 12 patients angiography was performed. All these showed a stenosis, 6 of which had more than > 75% stenosis. In 8 patients with normal echo-Doppler findings angiography was performed because of highly suggestive clinical signs of stenosis. In 7 of these no stenosis was found and in one a 50% stenosis was found. Comparison of quantitative Doppler spectrum features from patients with (n = 6) and without severe (> 75%) stenosis on angiography (n = 10) showed significant differences in several Doppler parameters. Subsequently an analysis of the best differentiation between these to groups on the basis of quantitative Doppler criteria was performed. In conclusion, echo-Doppler examinations with quantitative analysis of Doppler spectra enables reliable identification of renal allograft artery stenosis.