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Renal Artery Stenosis - PowerPoint PPT Presentation


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Renal Artery Stenosis. Case Studies. Coronal view of the proximal right RA (notice the high color velocity). Case #1= 52 yr. old male with severe HTN. IVC. Aorta. Case #1. Not a true peak velocity. Duplex scale is set too low ( 1.0 m/sec ). There is a musical bruit from a tight stenosis.

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case 1
Case #1

Not a true peak velocity. Duplex scale is set too low ( 1.0 m/sec ). There is a musical bruit from a tight stenosis.

case 14
Case #1

True peak velocity. Duplex scale set properly ( 4.0 m/s ).

case 15
Case #1

Tardus-parvus seen in the segmental artery, indicating a proximal tight stenosis.

case 16
Case #1

Right renal artery pre-angioplasty, you can see the tight stenosis involving the proximal right renal artery ( arrow ).

case 17
Case #1

Right renal artery post angioplasty , the stenosis has resolved.

case 18
Case #1

Same right renal artery post-angioplasty.

case 19
Case #1

Normal color velocity in the right renal artery after angioplasty ( arrow ).

case 110
Case #1

Velocity returns to normal.

case 111
Case #1

Segmental waveform returns to normal .

case 2 40 year old male with htn
Case # 2 : 40 year old male with HTN

This patient had normal velocities in the proximal renal arteries bilaterally. But, the mid and distal renal arteries, both right and left had very high velocities, with tardus-parvus seen in the segmental arteries.

slide15

Case #2

Rounded waveforms in the segmental right renal artery

Segmental RRA

case 2
Case #2

High velocities seen in the mid left renal artery

Mid LRA

case 217
Case #2

High velocities seen in the distal left renal artery

Distal LRA

case 2 rar calculation
Case #2 : RAR calculation

Ultrasound worksheet:

RAR in the Mid and Distal renal arteries are above 3.5 bilaterally, along with velocities above 180 cm/s, indicating a stenosis above 60%.

case 3 fibromuscular dysplasia
Case #3: Fibromuscular Dysplasia
  • Typical Angiographic appearance:
  • Beaded appearance of vessels
  • Mid and distal segments affected only.
  • This is where the ultrasound showed high velocities
case 321
Case #3

Post angioplasty. The arteries now have a smooth appearance. The blood pressure also returned to normal.

case 4
Case #4

72 year old female with HTN and increased BUN & Creatinine.

Rt >2.8 cm than Lt.

case 430
Case #4

Proximal right RA with increased velocity.

case 431
Case #4

Abnormal Mid right renal artery

case 432
Case #4

Proximal left renal artery.

case 433
Case #4

Mid left renal artery. Notice the blunting of the mid artery’s waveform.

case 434
Case #4

Segmental left renal artery, has blunted waveform also.

case 435
Case #4

Angio confirms ultrasound findings of a bilateral high grade stenosis. The left renal artery is severely diseased.

Left renal artery

case 5 elderly male with htn
Case #5: Elderly male with HTN

Proximal right renal artery with elevated velocity.

case 5
Case #5

Segmental artery with Tardus-Parvus. Notice

abnormal acceleration index.

case 438
Case #4

Post stent placement in the right artery. Left renal artery too diseased to stent.

case 539
Case #5

Example of a high grade stenosis with a normal segmental waveform. (absent Tardus-parvus). Remember not ALWAYS present in patients with a renal artery stenosis.

summary
Summary

Although Angiography is still considered the gold standard, Renal Artery Doppler is a very useful noninvasive screening test for renal artery stenosis.

If US suggests RAS, PT usually have Angiogram for confirmation and possible treatment.

If US normal, PT usually does not require further testing, sparing PT invasive risk and cost.