REVIEW ARTICLES   

International Angiology 2003 June;22(2):101-15

Copyright © 2003 EDIZIONI MINERVA MEDICA

lingua: Inglese

Duplex scan sonography of renal artery stenosis

Rabbia C. ¹, Valpreda S. ²

¹ Department of Vascular and Interventional Radiology, “San Giovanni Battista” Hospital, Turin, Italy 2 Department of Internal Medicine I, “San Giovanni Battista” Hospital, Turin, Italy

Renal ­artery sten­o­sis is the most com­mon cause of poten­tial­ly rem­e­di­able sec­on­dary hyper­ten­sion. The most com­mon caus­es ­include ath­ero­scler­o­sis and fibro­mus­cu­lar dys­pla­sia. Par­tic­u­lar­ly the ath­e­ros­cle­rot­ic form is a pro­gres­sive dis­ease that may lead to grad­u­al and ­silent loss of renal func­tion­al tis­sue. Thus, early diag­no­sis of renal ­artery sten­o­sis is an impor­tant clin­i­cal objec­tive since inter­ven­tion­al ther­a­py may ­improve or cure hyper­ten­sion and pre­serve renal func­tion. Screen­ing for renal ­artery sten­o­sis is indi­cat­ed in the sus­pi­cion of ren­o­vas­cu­lar hyper­ten­sion or ischem­ic neph­rop­a­thy in order to iden­ti­fy ­patients in which an endo­lu­mi­nal or a sur­gi­cal revas­cu­lar­iza­tion is advis­able. In the ­recent years many non­in­va­sive tests have been pro­posed and eval­u­at­ed in the clin­i­cal prac­tice, in alter­na­tive to arter­i­og­ra­phy. These ­include nucle­ar scan, color Dop­pler sonog­ra­phy, CT angio­gra­phy and MR angio­gra­phy. Sonog­ra­phy is usu­al­ly the first diag­nos­tic modal­ity for the non inva­sive eval­u­a­tion of renal vas­cu­lar dis­ease with 95% sen­si­tiv­ity and 90% spec­i­fic­ity when per­formed in ded­i­cat­ed labor­a­to­ries. ­Despite sonog­ra­phy is high­ly affect­ed by oper­a­tor depen­dance, and it takes a lot of time to train good oper­a­tors, actu­al­ly is the best screen­ing test ­because it is not expen­sive, non inva­sive and accu­rate. When a dis­crep­an­cy ­exists ­between the clin­i­cal data and the ­results of US, other tests are man­da­to­ry.