Color-coded summation images in the evaluation of renal artery stenosis before and after percutaneous transluminal angioplasty

Abstract Background Endovascular therapy is the gold standard in patients with hemodynamic relevant renal artery stenosis (RAS) resistant to medical therapy. The severity grading of the stenosis as well as the result assessment after endovascular approach is predominantly based on visible estimations of the anatomic appearance. We aim to investigate the application of color-coded DSA parameters to gain hemodynamic information during endovascular renal artery interventions and for the assessment of the procedures´ technical success. Methods We retrospectively evaluated 32 patients who underwent endovascular renal artery revascularization and applied color-coded summation imaging on selected monochromatic DSA images. The differences in time to peak (dTTP) of contrast enhancement in predefined anatomical measuring points were analyzed. Furthermore, differences in systolic blood pressure values (SBP) and serum creatinine were obtained. The value of underlying diabetes mellitus as a predictor for clinical outcome was assessed. Correlation analysis between the patients´ gender as well as the presence of diabetes mellitus and dTTP was performed. Results Endovascular revascularization resulted in statistically significant improvement in 4/7 regions of interest. Highly significant improvement of perfusion in terms of shortened TTP values could be found at the segmental artery level and in the intrastenotical segment (p < 0.001), significant improvement prestenotical and in the apical renal parenchyma (p < 0.05). In the other anatomic regions, differences revealed not to be significant. Differences between SBP and serum creatinine levels before and after the procedure were significant (p = 0.004 and 0.0004). Patients´ gender as well as the presence of diabetes mellitus did not reveal to be predictors for the clinical success of the procedure. Furthermore, diabetes and gender did not show relevant correlation with dTTP in the parenchymal measuring points. Conclusions The supplementary use of color-coding DSA and the data gained from parametric images may provide helpful information in the evaluation of the procedures´ technical success. The segmental artery might be a particularly suitable vascular territory for analyzing differences in blood flow characteristics. Further studies with larger cohorts are needed to further confirm the diagnostic value of this technique.

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Predictors for Clinical Success at One Year following Renal Artery Stent Placement

Journal of Endovascular Therapy ◽

10.1177/152660280200900419 ◽

2002 ◽

Vol 9 (4) ◽

pp. 495-502 ◽

Cited By ~ 6

Author(s):

Trude C. Gill-Leertouwer ◽

Elma J. Gussenhoven ◽

Johanna L. Bosch ◽

Jaap Deinum ◽

Hans van Overhagen ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Stent Placement ◽

Clinical Success ◽

Artery Stenosis ◽

Renal Function Impairment ◽

Function Impairment ◽

Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

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THE DIAGNOSTIC VALUE OF LEVOVIST IN DOPPLER IMAGING OF RENAL ARTERY STENOSIS IN PATIENTS WITH RENOVASCULAR HYPERTENSION BEFORE AND AFTER ANGIOPLASTY

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-2005-917652 ◽

2005 ◽

Vol 26 (S 1) ◽

Author(s):

A Drelich-Zbroja ◽

T Jargiello ◽

G Drelich ◽

H Lewandowska-Stanek ◽

M Szczerbo-Trojanowska

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Renovascular Hypertension ◽

Diagnostic Value ◽

Artery Stenosis ◽

Doppler Imaging ◽

Before And After

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Renal artery embolization for iatrogenic renal vascular injuries management: 5 years’ experience

British Journal of Radiology ◽

10.1259/bjr.20190256 ◽

2020 ◽

Vol 93 (1106) ◽

pp. 20190256 ◽

Cited By ~ 1

Author(s):

Andrea Contegiacomo ◽

Enrico Maria Amodeo ◽

Alessandro Cina ◽

Carmine Di stasi ◽

Roberto Iezzi ◽

...

Keyword(s):

Serum Creatinine ◽

Renal Artery ◽

Clinical Success ◽

Clinical Success Rate ◽

Vascular Injuries ◽

Technical Success ◽

Artery Embolization ◽

Renal Artery Embolization ◽

Embolic Materials ◽

Renal Vascular

Objective: Evaluate the efficacy and safety of renal artery embolization (RAE) for iatrogenic renal vascular injuries (IRVI) management at Fondazione Policlinico Universitario "A. Gemelli" IRCCS, in the last 5 years. Methods: Retrospective analysis of all RAE procedures performed from January 2013 to December 2017. Patients-related (age, sex, vascular variants, hemoglobin and serum creatinine), IRVI-related (type and vascular level of IRVI, presence and extension of hematoma), management-related (temporal interval between diagnostic imaging and RAE) and procedure-related (embolic materials, technical success, clinical success and complications) parameters were evaluated. Results: 28 RAE procedures performed on 28 patients (21 males; 7 females) were included. 19/28 patients had pseudoaneurysm, 7/28 active bleeding and 1/28 arteriovenous fistula; 4/28 patients had a combination of 2 IRVI. The extent of perirenal hematoma showed correlation with the cause of IRVI (p = 0.028). Technical success was achieved in all patients whereas clinical success in 25/28 (89.3%), with 3 patients requiring re-treatment. Minor complications were observed during 2/28 (7.1%) endovascular procedures. No major complications occurred. A longer procedural time was observed in patients with lower pre-procedural levels of hemoglobin (p = 0.016). No differences were found in mean serum creatinine (p = 0.23) before and immediately after treatment, while values of creatinine at 1 week from the procedure were significantly lower (p = 0.04). Conclusion: RAE is safe and effective for the management of iatrogenic IRVI showing high technical and clinical success rate and low complication rate. Advances in knowledge: Low pre-procedural hemoglobin levels increase procedural duration time. Glue alone or in combination with other materials is as safe as coils.

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The prevalence of renal artery stenosis among patients with diabetes mellitus

European Journal of Internal Medicine ◽

10.1016/j.ejim.2012.06.003 ◽

2012 ◽

Vol 23 (7) ◽

pp. 639-642 ◽

Cited By ~ 8

Author(s):

C.T. Postma ◽

E.M. Klappe ◽

H.M. Dekker ◽

Th. Thien

Keyword(s):

Diabetes Mellitus ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Patients With Diabetes

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Prevalence of renal artery stenosis in diabetes mellitus - an autopsy study

Journal of Internal Medicine ◽

10.1111/j.1365-2796.1991.tb00382.x ◽

1991 ◽

Vol 229 (6) ◽

pp. 489-492 ◽

Cited By ~ 91

Author(s):

P. T. SAWICKI ◽

S. KAISER ◽

L. HEINEMANN ◽

H. FRENZEL ◽

M. BERGER

Keyword(s):

Diabetes Mellitus ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Autopsy Study

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Transplant renal artery stenosis: hypertension and graft function before and after angioplasty

Journal of Human Hypertension ◽

10.1038/sj.jhh.1001256 ◽

2001 ◽

Vol 15 (10) ◽

pp. 741-743 ◽

Cited By ~ 3

Author(s):

B Agroyannis ◽

D Mourikis ◽

H Tzanatos ◽

A Chatzioannou ◽

DV Vlahakos ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Graft Function ◽

Artery Stenosis ◽

Transplant Renal Artery Stenosis ◽

Before And After

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EVALUATION OF RENAL FUNCTION IN PATIENTS WITH ATHEROSCLEROTIC RENAL ARTERY STENOSIS BEFORE AND AFTER ENDOVASCULAR TREATMENT

Journal of Hypertension ◽

10.1097/00004872-200402001-00677 ◽

2004 ◽

Vol 22 (Suppl. 1) ◽

pp. S158

Author(s):

A MPN Silva ◽

L M Monsignore ◽

F Nobre ◽

M CM Cardoso ◽

T JM Geleilete ◽

...

Keyword(s):

Renal Function ◽

Renal Artery ◽

Endovascular Treatment ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis ◽

Before And After

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INTRARENAL DOPPLER FLOW BEFORE AND AFTER I.V. ACE-INHIBITOR IN PATIENTS WITH UNILATERAL RENAL ARTERY STENOSIS

Journal of Hypertension ◽

10.1097/00004872-200406002-00394 ◽

2004 ◽

Vol 22 (Suppl. 2) ◽

pp. S113

Author(s):

A. Voiculescu ◽

M. Schmitz ◽

J. Plum ◽

S. Vupora ◽

D. Graebing ◽

...

Keyword(s):

Renal Artery ◽

Renal Artery Stenosis ◽

Ace Inhibitor ◽

Artery Stenosis ◽

Doppler Flow ◽

Before And After

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Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

Journal of Endovascular Therapy ◽

10.1177/15266028211038593 ◽

2021 ◽

pp. 152660282110385

Author(s):

David Eugenio Hinojosa-Gonzalez ◽

Gustavo Salgado-Garza ◽

Mauricio Torres-Martinez ◽

Sergio Uriel Villegas-De Leon ◽

Luis Carlos Bueno-Gutierrez ◽

...

Keyword(s):

Systematic Review ◽

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Serum Creatinine Level ◽

Endovascular Treatment ◽

Renal Artery Stenosis ◽

Creatinine Level ◽

Mean Difference ◽

Artery Stenosis

Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

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