Intraoperative renal duplex sonography: a valuable method for evaluating renal artery reconstructions

Objectives: to determine the ability of duplex sonography to intraoperative ly detect technical problems with renal artery reconstructions. Design: retrospective evaluation of a standard protocol. Patients and methods: the outcome of intraoperative duplex runs compared wi th postoperative angiography, surface duplex, MRA, echo or direct inspectio n in case of re-exploration in 77 renal artery reconstructions in 62 patien ts. These included six extracorporeal reconstructions, eight and 17 reconst ructions with an artery and autogenous vein respectively, 10 renal artery r e-implantations in the aorta (prosthesis), 32 endarterectomies and four rec onstructions of kidney transplant vessels. Results: intraoperative duplex was normal in 67/73 reconstructions with suf ficient data. In six cases technical problems were revealed by intraoperati ve duplex and the reconstruction was re-explored. After re-exploration intr aoperative duplex was normal in all cases. Confirmatory studies demonstrate d normal results in 61/64 reconstructions with normal intraoperative duplex and abnormal results in 6/6 reconstructions with technical problems reveal ed by intraoperative duplex. Three reconstructions with normal intraoperati ve duplex occluded as demonstrated by angiography less than 2 weeks after s urgery. Conclusions: renal duplex sonography is a valuable method available for int raoperative detection of technical problems. Haemodynamic duplex data were less important than B-mode imaging in discriminating between normal and abn ormal reconstruction.