RENAL DUPLEX SONOGRAPHY AFTER TREATMENT OF RENOVASCULAR DISEASE

Purpose: To define the value of renal duplex sonography (RDS) to detec t the presence of critical renal artery (RA) stenosis or occlusion aft er surgical repair or percutaneous transluminal balloon angioplasty (P FRA), we retrospectively reviewed our recent 71-month experience. Meth ods: From January 1987 through November 1992, 272 patients underwent 2 79 operative RA repairs and 35 patients underwent PTRA. Three hundred twenty-five RDS examinations were performed in 176 patients after oper ative intervention or PTRA during the study period. Forty-one of these patients had conventional angiography providing 61 RA for RDS compari son, and these data form the basis of this analysis. Twenty-four women and 17 men (mean age 57 years) underwent 44 operative RA repairs or 1 7 PTRA for correction of atherosclerotic disease (51 arteries) or fibr omuscular dysplasia (10 arteries). Before their renovascular procedure each patient had significant hypertension (mean 193/106 mm Hg). RDS a fter surgery or PTRA was technically complete for all 61 RA. Results: Compared with angiography RDS correctly identified 47 of 48 repairs wi th less than 60% RA stenosis, 7 of 11 repairs with 60% to 99% stenosis , and 2 renal artery occlusions, providing a 69% sensitivity rate, 98% specificity rate, 90% positive predictive value, and a 92% negative p redictive value. These results were adversely affected by branch RA di sease, which accounted for three of four false-negative RDS study resu lts. For 50 kidneys undergoing correction of main RA disease, RDS demo nstrated an 89% sensitivity rate, 98% specificity rate, and 96% overal l accuracy. RDS results were equivalent for both surgical and PTRA tre atment. Conclusions: From this experience we conclude that RDS is usef ul for anatomic evaluation after surgical RA repair or PTRA. A negativ e RDS result excludes stenosis or occlusion of a main RA reconstructio n but does not exclude significant branch level disease.