1
|
Gubensek J. The Role of Ultrasound Examination in the Assessment of Suitability of Calcified Arteries for Vascular Access Creation-Mini Review. Diagnostics (Basel) 2023; 13:2660. [PMID: 37627919 PMCID: PMC10453329 DOI: 10.3390/diagnostics13162660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Arterial calcifications are present in 20-40% of patients with end-stage kidney disease and are more frequent among the elderly and diabetics. They reduce the possibility of arterio-venous fistula (AVF) formation and maturation and increase the likelihood of complications, especially distal ischemia. This review focuses on methods for detecting arterial calcifications and assessing the suitability of calcified arteries for providing inflow before the construction of an AVF. The importance of a clinical examination is stressed. A grading system is proposed for quantifying the severity of calcifications in the arteries of the arm with B-mode and Doppler ultrasound exams. Functional tests to assess the suitability of the artery to provide adequate inflow to the AVF are discussed, including Doppler indices (peak systolic velocity and resistive index during reactive hyperemia). Possible predictors of the development of distal ischemia are discussed (finger pressure, digital brachial index, acceleration and acceleration time), as well as the outcomes of AVFs placed on calcified arteries. It is concluded that a noninvasive ultrasound examination is probably the best tool for a morphologic and functional assessment of the arteries. An arterial assessment is of utmost importance if we are to create distal radiocephalic AVFs in our elderly patients whenever possible without burdening them with futile surgical attempts.
Collapse
Affiliation(s)
- Jakob Gubensek
- Center for Acute and Complicated Dialysis and Vascular Access, Department of Nephrology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; ; Tel.: +386-1-522-3112; Fax: +386-1-522-2292
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| |
Collapse
|
2
|
Liesenfeld LF, Brandl A. Influence of hyperthermic intraperitoneal chemotherapy on renal blood perfusion. Langenbecks Arch Surg 2023; 408:207. [PMID: 37222835 PMCID: PMC10209305 DOI: 10.1007/s00423-023-02948-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Hyperthermic intraperitoneal chemotherapy (HIPEC) is accompanied with an increased risk of acute kidney injury (AKI). Whether AKI is induced by chemotoxicity or hyperthermia-related changes in renal perfusion remains controversial. The influence of HIPEC on renal perfusion has not been evaluated in patients yet. METHODS Renal blood perfusion was assessed in ten patients treated with HIPEC by intraoperative renal Doppler pulse-wave ultrasound. Ultrasound (US) examinations were performed pre-, intra-, and postoperative with analyses of time-velocity curves. Patient demographics, surgical details, and data regarding renal function were recorded perioperatively. For evaluation of renal Doppler US to predict AKI, patients were divided in two groups with (AKI +) and without (AKI -) kidney injury. RESULTS Throughout HIPEC perfusion, neither significant nor consistent changes in renal perfusion could be observed. Postoperative AKI occurred in 6 of 10 participating patients. Intraoperative renal resistive index (RRI) values > 0.8 were observed in one patient developing stage 3 AKI according KDIGO criteria. At 30 min in perfusion, RRI values were significantly higher in AKI + patients. CONCLUSION AKI is a common and frequent complication after HIPEC, but underlying pathophysiology remains elusive. High intraoperative RRI values may indicate an increased risk of postoperative AKI. Present data challenges the relevance of hyperthermia-derived hypothesis of renal hypoperfusion with prerenal injury during HIPEC. More attention should be drawn towards chemotoxic-induced hypothesis of HIPEC-induced AKI and caution applying regimens containing nephrotoxic agents in patients. Further confirmatory and complementary studies on renal perfusion as well as pharmacokinetic HIPEC studies are required.
Collapse
Affiliation(s)
- Lukas F Liesenfeld
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Andreas Brandl
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| |
Collapse
|
3
|
Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About? J Clin Med 2023; 12:jcm12031097. [PMID: 36769746 PMCID: PMC9917724 DOI: 10.3390/jcm12031097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/13/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
In recent years, the assessment of systolic acceleration in lower-extremity peripheral artery disease (PAD) has been brought back into the spotlight, whatever measure is used: time (in s) or acceleration (in cm.s-2). Acceleration time (also called systolic rise time) and maximal acceleration are two different but very useful measurements of growing interest in PAD. A background of the historical development, physics rationale, semantics, and methods of measurement, as well as their strengths and weaknesses, are discussed herein. Acceleration time is a powerful tool for predicting significant arterial stenosis or for estimating the overall impact of PAD as it is highly correlated to the ankle or toe pressure indexes. It could even become a new diagnostic criterion for critical limb ischemia. Similarly, maximal systolic acceleration ratios are highly predictive of carotid or renal stenosis. However, the literature lacks reference standards or guidelines for the assessment of such variables, and their measurement techniques seem to differ between authors. We propose herein a semantic and measurement statement order to clarify and help standardize future research.
Collapse
|
4
|
Williamson HM, Bartlett M, Desai M. Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study. JRSM Cardiovasc Dis 2022; 11:20480040211070481. [PMID: 35083041 PMCID: PMC8785324 DOI: 10.1177/20480040211070481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Ankle brachial pressure index (ABPI) is limited for diabetic patients. This can have costly impacts upon patient's quality of life along with healthcare budgets, with diabetic care equating to approximately 10% of NHS expenditure.11 We aimed to determine whether ultrasound waveform parameters are an alternative for quantifying lower extremity peripheral arterial disease (PAD) where ABPI is unreliable.
Design: This was a prospective, observational study. Waveform parameters, systolic rise time (SRT), maximal systolic acceleration (AccMax) and peak systolic velocity (PSV) were recorded at ankle and compared to the ABPI and an aorta-ankle duplex ultrasound scan (DUS) as gold standard.
Setting: Measurements were obtained by a Clinical Vascular Scientist at the Royal Free Hospital.
Participants: Participants (≥18yrs) with known PAD, but without previous vascular intervention were allocated to non-diabetic control (n = 24) and diabetic test groups (n = 22).
Outcome measures: The primary outcome measure was the correlation of novel ultrasound derived indices to PAD severity. The secondary outcome was the efficacy of this correlation in the diabetic population.
Results: AccMax was most powerful in detecting PAD in both groups when compared to ABPI in the controls (r = 0.805; p < 0.01) and to DUS in control and test groups (r = −0.633 to −0.643; p < 0.01). In the test group, PSV did not consistently quantify PAD. SRT measurements were inconclusive throughout.
Conclusion: AccMax is a rapid alternative tool for diagnosing PAD in diabetic patients. With further research, this simple test may prove useful for monitoring PAD progression in patients unsuitable for ABPI, reducing the need for lengthy repeat duplex scans.
Collapse
Affiliation(s)
| | - Matthew Bartlett
- Royal Free London NHS Foundation Trust, Vascular Studies, London, UK
- Department of Surgery & Interventional Medicine, University College London, London, UK
| | - Mital Desai
- Department of Surgery & Interventional Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, Vascular Surgery, London, UK
| |
Collapse
|
5
|
Brouwers JJWM, Jiang JFY, Feld RT, van Doorn LP, van Wissen RC, van Walderveen MAA, Hamming JF, Schepers A. A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration. Ann Vasc Surg 2021; 81:202-210. [PMID: 34780944 DOI: 10.1016/j.avsg.2021.09.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Doppler ultrasonography (DUS) is used as initial measurement to diagnose and classify carotid artery stenosis. Local distorting factors such as vascular calcification can influence the ability to obtain DUS measurements. The DUS derived maximal systolic acceleration (ACCmax) provides a different way to determine the degree of stenosis. While conventional DUS parameters are measured at the stenosis itself, ACCmax is measured distal to the internal carotid artery (ICA) stenosis. The value of ACCmax in ICA stenosis was investigated in this study. MATERIAL AND METHODS All carotid artery DUS studies of a tertiary academic center were reviewed from October 2007 until December 2017. Every ICA was included once. The ACCmax was compared to conventional DUS parameters: ICA peak systolic velocity (PSV), and PSV ratio (ICA PSV/ CCA PSV). ROC-curve analysis was used to evaluate accuracy of ACCmax, ICA PSV and PSV ratio as compared to CT-angiography (CTA) derived stenosis measurement as reference test. RESULTS The study population consisted of 947 carotid arteries and was divided into 3 groups: <50% (710/947), 50-69% (109/947), and ≥70% (128/947). Between these groups ACCmax was significantly different. Strong correlations between ACCmax and ICA PSV (R2 0.88) and PSV ratio (R2 0.87) were found. In ROC subanalysis, the ACCmax had a sensitivity of 90% and a specificity of 89% to diagnose a ≥70% ICA stenosis, and a sensitivity of 82% and a specificity of 88% to diagnose a ≥50% ICA stenosis. For diagnosing a ≥50% ICA stenosis the area under the curve (AUC) of ACCmax (0.88) was significantly lower than the AUC of PSV ratio (0.94) and ICA PSV (0.94). To diagnose a ≥70% ICA stenosis there were no significant differences in AUC between ACCmax (0.89), PSV ratio (0.93) and ICA PSV (0.94). CONCLUSIONS ACCmax is an interesting additional DUS measurement in determining the degree of ICA stenosis. ACCmax is measured distal to the stenosis and is not hampered by local distorting factors at the site of the stenosis. ACCmax can accurately diagnose an ICA stenosis, but was somewhat inferior compared to ICA PSV and PSV ratio to diagnose a ≥50% ICA stenosis.
Collapse
Affiliation(s)
- Jeroen J W M Brouwers
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands; Department of Surgery, HagaHospital, The Hague, The Netherlands.
| | - Janey F Y Jiang
- Department of Radiology, Leiden University Medical Center, The Netherlands
| | - Robert T Feld
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Louk P van Doorn
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Rob C van Wissen
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | | | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| | - Abbey Schepers
- Department of Vascular Surgery, Leiden University Medical Center, The Netherlands
| |
Collapse
|
6
|
Bardelli M, Cavressi M, Furlanis G, Pinamonti B, Leone M, Albani S, Korcova R, Fabris B, Sinagra G. Relationship between aortic valve stenosis and the hemodynamic pattern in the renal circulation, and restoration of the flow wave profile after correction of the valvular defect. J Int Med Res 2021; 48:300060520956907. [PMID: 32967509 PMCID: PMC7521054 DOI: 10.1177/0300060520956907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The index of maximal systolic acceleration ([AImax]: maximal systolic acceleration of the Doppler waveform divided by peak systolic velocity) shows diagnostic accuracy in screening of renal artery stenosis. This study aimed to determine whether an upstream factor of resistance, such as aortic valve stenosis (AVS), can affect Doppler parameters detected in the peripheral arteries. METHODS In this prospective study, we measured the AImax in non-stenotic renal interlobar arteries of 62 patients with AVS. Patients were divided into three groups on the basis of severity of valvulopathy as follows: mild-to-moderate AVS (M-AVS; n = 24), intermediate AVS (I-AVS; n = 15), and severe AVS (S-AVS; n = 23) based on Nishimura's criteria. RESULTS The AImax in the renal parenchymal arteries was significantly lower in the S-AVS group (8.9 ± 3.6 s-1) than in the M-AVS (15.3 ± 3.8 s-1) and I-AVS groups (16.7 ± 5.2 s-1). The AImax was positively correlated with the aortic valve area and inversely correlated with the tranvalvular aortic pressure gradient. After aortic valve replacement, the AImax significantly increased from 10.7 ± 4.0 s-1 at baseline to 19.3 ± 4.4 s-1. CONCLUSIONS Proximal resistance can lead to diagnostic bias of Doppler parameters that are applied in the diagnosis of peripheral vasculopathies, particularly in renal artery stenosis.
Collapse
Affiliation(s)
- Moreno Bardelli
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy.,Dipartimento Assistenziale Integrato di Medicina Interna e Nefrologia - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Monica Cavressi
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy
| | - Giulia Furlanis
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy
| | - Bruno Pinamonti
- Dipartimento Assistenziale Integrato Cardiotoracovascolare - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Mariafontana Leone
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy
| | - Stefano Albani
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy
| | - Renata Korcova
- Dipartimento Assistenziale Integrato Cardiotoracovascolare - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Bruno Fabris
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy.,Dipartimento Assistenziale Integrato di Medicina Interna e Nefrologia - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianfranco Sinagra
- Dipartimento di Scienze Mediche Chirurgiche e della Salute - Università di Trieste, Trieste, Italy.,Dipartimento Assistenziale Integrato Cardiotoracovascolare - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| |
Collapse
|
7
|
Januszewicz M, Dobrowolski P, Januszewicz A, Warchoł-Celińska E, Jóźwik-Plebanek K, Motyl D, Kabat M, Pęczkowska M, Michałowska I, Ambroziak U, Toutounchi S, Gałązka Z, Courcelles L, Pappaccogli M, Eisenhofer G, Persu A, Lenders JWM, Kądziela J, Prejbisz A. Intrarenal hemodynamics and kidney function in pheochromocytoma and paraganglioma before and after surgical treatment. Blood Press 2021; 30:172-179. [PMID: 33586556 DOI: 10.1080/08037051.2020.1851590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Current evidence regarding renal involvement in pheochromocytoma and paraganglioma (PPGL) is scant. More accurate diagnostic methods, such as renal Doppler ultrasound for intrarenal hemodynamic studies, may provide more detailed information on renal function. It might be postulated that renal function in PPGL patients might be altered by high blood pressure and excess secretion of catecholamines. The aim of this prospective study was to assess intrarenal blood flow parameters in PPGL patients included in the prospective monoamine-producing tumour (PMT) study and to evaluate the effects of normalisation of catecholamine production after surgical treatment on long-term renal function. MATERIALS AND METHODS Seventy consecutive patients (aged 46.5 ± 14.0 years) with PPGL were included. Forty-eight patients from the PMT study cohort, matched for age, gender, blood pressure level and presence of hypertension, served as a control group. Renal artery doppler ultrasound spectral analysis included mean resistance index (RRI) and pulsatility index (PI). Forty-seven patients completed 12 months follow-up. RESULTS There were no differences in renal parameters such as RRI, PI and kidney function between PPGL and non-PPGL patients as assessed by renal ultrasound, serum creatinine, eGFR and albumin excretion rate. No correlations between kidney function parameters, intrarenal doppler flow parameters and plasma catecholamines were observed in PPGL patients. At 12 months after surgery, no differences in creatinine level, eGFR, albumin excretion rate, RI and PI were found as compared to baseline results. CONCLUSIONS In contrast to patients with other forms of secondary hypertension, our study did not show differences in intrarenal blood flow parameters and renal function between PPGL and non-PPGL subjects. Intrarenal hemodynamics and renal function did not change after normalisation of catecholamine levels by surgical treatment.
Collapse
Affiliation(s)
- Magdalena Januszewicz
- Department of Radiology, Medical University of Warsaw, Warsaw, Poland.,Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | | | | | - Daria Motyl
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Marek Kabat
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Mariola Pęczkowska
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Ilona Michałowska
- Department of Radiology, National Institute of Cardiology, Warsaw, Poland
| | - Urszula Ambroziak
- Department of Internal Diseases and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Sadegh Toutounchi
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gałązka
- Department of General, Endocrinological and Vascular Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Louisiane Courcelles
- Department of Laboratory Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marco Pappaccogli
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Graeme Eisenhofer
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques W M Lenders
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacek Kądziela
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
8
|
Pappelis K, Choritz L, Jansonius NM. Microcirculatory model predicts blood flow and autoregulation range in the human retina: in vivo investigation with laser speckle flowgraphy. Am J Physiol Heart Circ Physiol 2020; 319:H1253-H1273. [PMID: 32986964 DOI: 10.1152/ajpheart.00404.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this study, we mathematically predict retinal vascular resistance (RVR) and retinal blood flow (RBF), we test predictions using laser speckle flowgraphy (LSFG), we estimate the range of vascular autoregulation, and we examine the relationship of RBF with the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC). Fundus, optical coherence tomography (OCT), and OCT-angiography images, systolic/diastolic blood pressure (SBP/DBP), and intraocular pressure (IOP) measurements were obtained from 36 human subjects. We modeled two circulation markers (RVR and RBF) and estimated individualized lower/higher autoregulation limits (LARL/HARL), using retinal vessel calibers, fractal dimension, perfusion pressure, and population-based hematocrit values. Quantitative LSFG waveforms were extracted from vessels of the same eyes, before and during IOP elevation. LSFG metrics explained most variance in RVR (R2 = 0.77/P = 6.9·10-9) and RBF (R2 = 0.65/P = 1.0·10-6), suggesting that the markers strongly reflect blood flow physiology. Higher RBF was associated with thicker RNFL (P = 4.0·10-4) and GCC (P = 0.003), thus also verifying agreement with structural measurements. LARL was at SBP/DBP of 105/65 mmHg for the average subject without arterial hypertension and at 115/75 mmHg for the average hypertensive subject. Moreover, during IOP elevation, changes in RBF were more pronounced than changes in RVR. These observations physiologically imply that healthy subjects are already close to LARL, thus prone to hypoperfusion. In conclusion, we modeled two clinical markers and described a novel method to predict individualized autoregulation limits. These findings could improve understanding of retinal perfusion and pave the way for personalized intervention decisions, when treating patients with coexisting ophthalmic and cardiovascular pathologies.NEW & NOTEWORTHY We describe and test a new approach to quantify retinal blood flow, based on standard clinical examinations and imaging techniques, linked together with a physiological model. We use these findings to generate individualized estimates of the autoregulation range. We provide evidence that healthy subjects are closer to the lower autoregulation limit than thought before. This suggests that some retinas are less prepared to withstand hypoperfusion, even after small intraocular pressure rises or blood pressure drops.
Collapse
Affiliation(s)
- Konstantinos Pappelis
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Lars Choritz
- University Eye Clinic, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Nomdo M Jansonius
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Asbeutah AM, Adekile A, AlMajran AA, Asbeutah AAA, Naief AA, Al-Jafar H. Pattern of Renal Blood Flow and Renovascular Parameters in Adult Patients With Sickle Cell Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:785-793. [PMID: 31663639 DOI: 10.1002/jum.15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate renal blood flow patterns and renovascular parameters in adult patients with sickle cell disease (SCD) without laboratory evidence of renal impairment. METHODS Sixty-five steady-state adult patients with SCD (50 hemoglobin SS [HbSS], 12 HbSβ0 , and 3 HbSD) and 30 age- and sex-matched healthy controls were studied. The kidney length, echo pattern, peak systolic velocity (PSV), end-diastolic velocity, renal-to-aortic ratio, resistive index (RI), acceleration time (AT), and renal vein velocity were acquired, recorded, and analyzed with a 1-5-MHz curvilinear transducer through the abdomen. RESULTS The mean age ± SD of the patients with SCD was 32.89 ± 13.89 years. The highest means for the ultrasound-measured renal length and cortical thickness in the SCD and control groups were 11.78 ± 1.30 and 11.27 ± 0.77 cm and 1.86 ± 0.41 and 1.78 ± 0.28 cm, respectively. The figures were significantly higher in the SCD group than the control group (P < .05). Fifty-nine (90.8%) patients had a mild diffuse increase in cortical echogenicity with preserved renal cortical thickness. The highest mean extrarenal PSVs in the SCD and control groups were 138.46 ± 56.32 and 101.75 ± 31.48 cm/s (P < .05). However, the highest intrarenal RI and AT in SCD and control groups were 0.69 ± 0.07 and 0.06 ± 0.02 seconds and 0.63 ± 0.05 and 0.04 ± 0.01 seconds (P < .05). There was no significant correlation between the RI, AT, and PSV among the patients with SCD (P > .05). CONCLUSIONS Increased renal length and cortical echogenicity with elevated PSV, RI, and AT values can serve as early ultrasound changes in adult patients with SCD without renal impairment.
Collapse
Affiliation(s)
- Akram M Asbeutah
- Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University, Sulaibekhat, Kuwait
- Department of Clinical Radiology, Al-Sabah Hospital, Ministry of Health, Sulaibekhat, Kuwait
- Department of Hematology, Al-Amiri Hospital, Ministry of Health, Sulaibekhat, Kuwait
| | - Adekunle Adekile
- Departments of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Abdullah A AlMajran
- Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Abdul Aziz A Asbeutah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Athbi A Naief
- Department of Clinical Radiology, Al-Sabah Hospital, Ministry of Health, Sulaibekhat, Kuwait
| | - Hassan Al-Jafar
- Department of Radiologic Sciences, Faculty of Allied Health Sciences, Kuwait University, Sulaibekhat, Kuwait
- Department of Hematology, Al-Amiri Hospital, Ministry of Health, Sulaibekhat, Kuwait
| |
Collapse
|
10
|
Brouwers JJ, van Doorn LP, van Wissen RC, Putter H, Hamming JF. Using maximal systolic acceleration to diagnose and assess the severity of peripheral artery disease in a flow model study. J Vasc Surg 2020; 71:242-249. [DOI: 10.1016/j.jvs.2019.01.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/11/2019] [Indexed: 12/27/2022]
|
11
|
Hamroun A, Frimat M, Beuscart JB, Buob D, Lionet A, Lebas C, Daroux M, Provôt F, Hazzan M, Boulanger É, Glowacki F. [Kidney disease care for the elderly]. Nephrol Ther 2019; 15:533-552. [PMID: 31711751 DOI: 10.1016/j.nephro.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In our aging population, kidney disease management needs to take into account the frailty of the elderly. Standardized geriatric assessments can be proposed to help clinicians apprehend this dimension in their daily practice. These tools allow to better identify frail patients and offer them more personalized and harmless treatments. This article aims to focus on the kidney diseases commonly observed in elderly patients and analyze their specific nephrogeriatric care modalities. It should be noticed that all known kidney diseases can be also observed in the elderly, most often with a quite similar clinical presentation. This review is thus focused on the diseases most frequently and most specifically observed in elderly patients (except for monoclonal gammopathy associated nephropathies, out of the scope of this work), as well as the peculiarities of old age nephrological care.
Collapse
Affiliation(s)
- Aghilès Hamroun
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marie Frimat
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | | | - David Buob
- Service d'anatomopathologie, Centre de biologie-pathologie, CHRU de Lille, 59037 Lille, France
| | - Arnaud Lionet
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Céline Lebas
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Maïté Daroux
- Service de néphrologie, hôpital Duchenne, allée Jacques Monod, 62200 Boulogne-sur-Mer, France
| | - François Provôt
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Marc Hazzan
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France
| | - Éric Boulanger
- Service de gériatrie, CHRU de Lille, 59037 Lille, France
| | - François Glowacki
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 59037 Lille, France.
| |
Collapse
|
12
|
Bardelli M, Cavressi M, Furlanis G. Valvular and/or Non-valvular Aortic Pathology Can Bias the Ultrasonographic Diagnosis of Renal Artery Stenosis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2942-2949. [PMID: 31439362 DOI: 10.1016/j.ultrasmedbio.2019.07.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
Renal artery stenosis (RAS) has been shown to cause a reduction in the index of maximal systolic acceleration (AImax: the maximal acceleration of flow waveform in early systole divided by the peak systolic velocity) of blood in the renal interlobar arteries, caused by local dampening of the pulse wave. In previous studies, AImax demonstrated diagnostic accuracy in terms of negative predictive value, which is useful for screening, but had a relatively low specificity. We hypothesized that an upstream focal resistance, such as an aortic stenosis or aneurysm, could act in the same way as RAS, thus generating false positives in non-stenotic kidneys. We studied 226 patients who underwent a complete protocol for RAS screening. AImax was 6.2 ± 2.9 s-1 and 13.4 ± 3.5 s-1 (mean ± standard deviation) in stenotic and non-stenotic kidneys, respectively. Diagnostic accuracy of ultrasonography with respect to the benchmark of renal computed tomography or magnetic resonance angiography (significant RAS cutoff ≥50%) resulted in 97% sensitivity, 94% specificity and a negative and positive predictive value of 99% and 55%, respectively. Using logistic regression for unexpectedly low AImax in non-stenotic kidneys (AImax cutoff ≤ 9.0 s-1), aortic pathology, such as aortic valve stenosis or aortic arch dilation (as assessed by echocardiography), was found to be the only significant predictor (Χ2 = 33.8, p < 0.0001) of false positive cases compared with clinical and hemodynamic variables. We concluded that the aortic valvular and non-valvular pathology can act as a proximal resistance that can attenuate the Doppler flowmetric parameters, which explore the flow waveform in the renal parenchymal arterial circulation, thus mimicking the presence of a focal resistance in the peripheral vascular region explored.
Collapse
Affiliation(s)
- Moreno Bardelli
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy.
| | - Monica Cavressi
- Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy
| | - Giulia Furlanis
- Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Hospital, Trieste, Italy
| |
Collapse
|
13
|
Chang CW, Wai YY, Lim SN, Wu T. Association Between Flow Acceleration in the Carotid Artery and Intracranial Aneurysms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1333-1340. [PMID: 30393875 DOI: 10.1002/jum.14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES In physiologic pulsatile flow, velocity acceleration is an independent factor determining wall shear stress experienced by the vascular endothelium. The purpose of this study was to evaluate Doppler indices of systolic velocity acceleration in extracranial cerebral vessels and the occurrence of intracranial aneurysms. METHODS We reviewed medical records and 3.0-T brain magnetic resonance imaging with 3-dimensional time-of-flight magnetic resonance angiography of 1323 adults who underwent health checkups from June 2006 to November 2011, in whom 53 intracranial aneurysms were identified in 45 patients. Doppler ultrasound parameters of the carotid and vertebral arteries were analyzed in these 45 patients with aneurysms and compared with another 45 control participants matched for age and sex. We defined the maximum systolic acceleration (ACCmax ) as the maximum slope of the early phase of systolic acceleration on the Doppler waveform and the maximum acceleration index (AImax ) as the ratio of the ACCmax and peak systolic velocity. RESULTS The Doppler analysis showed a significantly increased AImax and ACCmax in the common carotid artery (CCA), internal carotid artery, and vertebral artery in the aneurysm group. A cutoff 13.89 s-1 for the AImax of the CCA had sensitivity of 80% with a negative predictive value of 99% for intracranial aneurysms. CONCLUSIONS This study suggests that the AImax of the CCA with a cutoff of 13.89 s-1 may be an alternative to 3-dimensional time-of-flight magnetic resonance angiography or computed tomographic angiography as a screening tool for intracranial aneurysms. Further prospective studies are needed to validate the diagnostic performance and cost-effectiveness of these indices for screening.
Collapse
Affiliation(s)
- Chun-Wei Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yau-Yau Wai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelung, Taiwan
| | - Siew-Na Lim
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
- Department of Neurology, Xiamen Changgung Hospital, China
| |
Collapse
|
14
|
Buschmann EE, Li L, Brix M, Zietzer A, Hillmeister P, Busjahn A, Bramlage P, Buschmann I. A novel computer-aided diagnostic approach for detecting peripheral arterial disease in patients with diabetes. PLoS One 2018; 13:e0199374. [PMID: 29928037 PMCID: PMC6013098 DOI: 10.1371/journal.pone.0199374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/06/2018] [Indexed: 12/19/2022] Open
Abstract
Peripheral arterial disease (PAD) is an important manifestation of systemic atherosclerosis, with diabetes being one of its most significant risk factors. Owing to medial arterial calcification (MAC), the ankle–brachial index (ABI) is not always a reliable tool for detecting PAD. Arterial Doppler flow parameters, such as systolic maximal acceleration (ACCmax) and relative pulse slope index (RPSI), may serve as effective surrogates to detect stenosis-induced flow alteration. In the present study, ACCmax and RPSI were prospectively evaluated in 166 patients (304 arteries) with clinical suspicion of PAD, including 76 patients with and 90 patients without diabetes. In the overall sample, the sensitivity of ACCmax (69%) was superior to that of ABI (58%) and RPSI (56%). In patients with diabetes, the sensitivity of ACCmax (57%), ABI (56%) and RPSI (57%) were similar, though a parallel test taking both ACCmax and RPSI into account further increased sensitivity to 68%. The specificity (98%) and accuracy (78%) of ACCmax were superior to those of ABI (83% and 70%, respectively), as were the specificity (95%) and accuracy (77%) of RPSI in patients with diabetes. The diagnostic properties of ACCmax and RPSI were superior to those of ABI for detecting PAD in patients with diabetes. Our acceleration algorithm (Gefäßtachometer®) provides a rapid, safe, noninvasive tool for identifying PAD in patients with diabetes.
Collapse
Affiliation(s)
- Eva Elina Buschmann
- Dept. for Cardiology, Center of Internal Medicine, Medical University Graz, Graz, Austria
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- * E-mail:
| | - Lulu Li
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Michèle Brix
- Department of Physiology Charité Benjamin Franklin, Berlin, Germany
| | - Andreas Zietzer
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
- Medizinische Klinik II, Universität Bonn, Bonn, Germany
| | - Philipp Hillmeister
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Peter Bramlage
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Ivo Buschmann
- Dept. for Angiology, Center for Internal Medicine 1, Medical University Brandenburg (MHB), Brandenburg/ Havel, Germany
- Richard-Thoma Laboratories for Arteriogenesis, Center for Cardiovascular Research (CCR), Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Physiology Charité Benjamin Franklin, Berlin, Germany
| |
Collapse
|
15
|
Gunabushanam G, Millet JD, Stilp E, Crawford FW, McNamara RL, Scoutt LM. Computer-assisted detection of tardus parvus waveforms on Doppler ultrasound. ULTRASOUND (LEEDS, ENGLAND) 2018; 26:81-92. [PMID: 30013608 PMCID: PMC6042304 DOI: 10.1177/1742271x17747135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 10/26/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine if a novel computer-generated metric, effective acceleration time, improves accuracy for detecting tardus parvus waveforms on spectral Doppler ultrasound. METHODS Patients with echocardiography-confirmed aortic valve stenosis (n = 132; 60 mild, 44 moderate, 28 severe) and matched controls (n = 48) who underwent carotid Doppler ultrasound were identified through an imaging database search at a single medical center. A custom-built spectral analysis computer program generated effective acceleration time values for spectral Doppler waveforms in the carotid arteries and a receiver operating characteristic analysis was performed to determine the optimal median effective acceleration time cutoff value to detect tardus parvus waveforms. Two radiologists, blinded to subject disease status, reviewed and rated all carotid sonograms for presence of tardus parvus waveforms. Inter-rater variability was measured, and the accuracy of aortic valve stenosis detection with and without use of the effective acceleration time cutoff was calculated. RESULTS Receiver operating characteristic analysis revealed an optimal effective acceleration time cutoff of ≥ 48 ms with a corresponding area under the curve of 0.77 (95% CI: 0.70-0.84). Use of the effAT cutoff demonstrated an accuracy of 74%. Accuracy of visual waveform interpretation by raters ranged from 43% to 61%. Inter-rater agreement in detection of tardus parvus waveforms was 76% (136/180 cases, K = 0.44, p < 0.001). CONCLUSIONS Detection of tardus parvus waveforms through visual interpretation of spectral Doppler waveform morphology is limited by low accuracy and moderate inter-rater variability. Use of a computer-generated median effective acceleration time cutoff value markedly improves diagnostic accuracy and avoids observer variability.
Collapse
Affiliation(s)
- Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - John D Millet
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Erik Stilp
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Forrest W Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Robert L McNamara
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
16
|
Grupp C, Koziolek MJ, Wallbach M, Hoxhold K, Müller GA, Bramlage C. Difference between renal and splenic resistive index as a novel criterion in Doppler evaluation of renal artery stenosis. J Clin Hypertens (Greenwich) 2018; 20:582-588. [PMID: 29450973 DOI: 10.1111/jch.13212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/31/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022]
Abstract
Detection of renal artery stenosis (RAS) using Doppler is difficult to evaluate, particularly under conditions such as bilateral RAS or difficultly accessible renal arteries (RA). The objective of the present study was to assess the utility of splenic arterial compared to renal flow as an additional parameter in the Doppler evaluation of RAS. The difference between the resistive indices (RI) determined in renal and splenic parenchymal arteries (ΔRIK-S ) was evaluated in 181 hypertensive subjects without any evidence of RAS. Subsequently 47 RA in 24 patients with suspected RAS were angiographically assessed. A ΔRIK-S of 0.055 (median) was determined in the population without any evidence of RAS similar to RA with angiographically excluded stenosis (ΔRIK-S 0.068). In contrast, in angiographic proven RAS, ΔRIK-S was significantly lower (-0.050; P < .005). The assessment of the ΔRIK-S , proved to be an easily feasible parameter, which improves the diagnostic accuracy in the detection of RAS.
Collapse
Affiliation(s)
- Clemens Grupp
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Michael J Koziolek
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Kerstin Hoxhold
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Gerhard A Müller
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| | - Carsten Bramlage
- Department of Nephrology & Rheumatology, Georg-August-University Göttingen, Göttingen, Germany
| |
Collapse
|
17
|
Michelli A, Bernardi S, Grillo A, Panizon E, Rovina M, Bardelli M, Carretta R, Fabris B. A case report of malignant hypertension in a young woman. BMC Nephrol 2016; 17:65. [PMID: 27389397 PMCID: PMC4936255 DOI: 10.1186/s12882-016-0291-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/24/2016] [Indexed: 11/24/2022] Open
Abstract
Background Malignant hypertension is a condition characterized by severe hypertension and multi-organ ischemic complications. Albeit mortality and renal survival have improved with antihypertensive therapy, progression to end-stage renal disease remains a significant cause of morbidity and mortality. The underlying cause of malignant hypertension, which can be primary or secondary hypertension, is often difficult to identify and this can substantially affect the treatment outcomes, as we report here. Case presentation A 33-year-old woman presented with severe hypertension and acute renal failure. Initial evaluation demonstrated hyperreninemia with hyperaldosteronism and a possible renal artery stenosis at the contrast-enhanced CT scan. Although this data suggested the presence of a secondary form of hypertension, further exams excluded our first diagnosis of renal artery stenosis. Consequently, the patient did not undergo renal angiography (and the contrast media infusion associated with it), but she continued to be medically treated to achieve a tight blood pressure control. Our conservative approach was successful to induce renal function recovery over 2 years of follow-up. Conclusion This case highlights the difficulty in differentiating between primary and secondary forms of malignant hypertension, particularly when the patient presents with acute renal failure. Clinicians should consider renal artery ultrasound as a first level diagnostic technique, given that the presentation of primary malignant hypertension can often mimic a renal artery stenosis. Secondly, adequate control of blood pressure is essential for kidney function recovery, although this may require a long time.
Collapse
|
18
|
Brouwers JJ, van Wissen RC, Veger HT, Rotmans JI, Mertens B, Visser MJ. The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization. Vascular 2016; 25:63-73. [PMID: 27118604 DOI: 10.1177/1708538116644871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.
Collapse
Affiliation(s)
- Jeroen Jwm Brouwers
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Rob C van Wissen
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Hugo Tc Veger
- 2 Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Joris I Rotmans
- 3 Department of Nephrology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Bart Mertens
- 4 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Michel Jt Visser
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| |
Collapse
|
19
|
Abstract
The main objectives of this expert consensus are to raise awareness about fibromuscular dysplasia, which is more frequent and more often systemic than previously thought and can sometimes have devastating consequences; to provide up-to-date recommendations for the diagnosis, evaluation, and management of the disease; and to identify research priorities. The emphasis has been put on recommendations for daily practice. The main topics covered include definition, classification, diagnosis, and management of fibromuscular dysplasia in adult patients with symptomatic involvement of the renal arteries, supra-aortic trunks, and digestive and peripheral arteries.
Collapse
|
20
|
|
21
|
Pua U, Tan CH, Ho HH, Tan JKB, Ong PJL. Revisiting renovascular imaging for renal sympathetic denervation: current techniques and applications. Eur Radiol 2014; 25:444-53. [DOI: 10.1007/s00330-014-3392-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/31/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
|
22
|
de Vos MS, Bol BJ, Gravereaux EC, Hamming JF, Nguyen LL. Treatment planning for peripheral arterial disease based on duplex ultrasonography and computed tomography angiography: Consistency, confidence and the value of additional imaging. Surgery 2014; 156:492-502. [DOI: 10.1016/j.surg.2014.03.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/19/2014] [Indexed: 12/31/2022]
|
23
|
Li JC, Xu ZH, Yuan Y, Zhang YX, Wang L, Cai S, Wang YH, Jiang YX. Impact of atherosclerosis and age on Doppler sonographic parameters in the diagnosis of renal artery stenosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:747-755. [PMID: 22535722 DOI: 10.7863/jum.2012.31.5.747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the influence of atherosclerosis and age on 4 representative Doppler parameters in the diagnosis of renal artery stenosis. METHODS The 4 parameters, renal peak systolic velocity (PSV), renal-aortic ratio, renal-interlobar ratio, and acceleration time, were measured in 208 patients before angiography. The 208 patients were divided into groups according to age and atherosclerosis stratification. The Student t test, 1-way analysis of variance, and the χ(2) test were used to compare all 4 parameters and clinical characteristics. The optimal cutoff values were determined by receiver operating characteristic curves. The diagnostic concordance between atherosclerosis and age strata was evaluated by the Cohen κ coefficient. RESULTS Of the 416 renal arteries shown on Doppler sonography, 204 had a diagnosis of renal artery stenosis and 19 as occlusion on angiography. The optimal cutoff values for the renal-aortic ratio and renal-interlobar ratio in the groups aged 46 years or older and younger than 46 years were much different (2.3 versus 1.4 and 5.1 versus 6.5, respectively), whereas those for the renal PSV and acceleration time were close to each other or the same (170 versus 180 cm/s and 51 versus 51 milliseconds). The κ coefficients for the renal PSV, renal-interlobar ratio, acceleration time, and renal-aortic ratio between the atherosclerosis and age strata were 0.93, 0.99, 1.00, and 0.71. CONCLUSIONS Atherosclerosis and age show comparable influences on Doppler parameters in the diagnosis of renal artery stenosis. For clinical convenience, cutoff values may be separately established on the basis of a 46-year-old borderline for the renal-aortic ratio and renal-interlobar ratio, although this process is not necessary for the renal PSV and acceleration time.
Collapse
Affiliation(s)
- Jian-Chu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Persu A, Touzé E, Mousseaux E, Barral X, Joffre F, Plouin PF. Diagnosis and management of fibromuscular dysplasia: an expert consensus. Eur J Clin Invest 2012; 42:338-47. [PMID: 21854373 DOI: 10.1111/j.1365-2362.2011.02577.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Margey R, Hynes BG, Moran D, Kiernan TJ, Jaff MR. Atherosclerotic renal artery stenosis and renal artery stenting: an evolving therapeutic option. Expert Rev Cardiovasc Ther 2011; 9:1347-60. [PMID: 21985547 DOI: 10.1586/erc.11.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atherosclerotic renal artery stenosis is a common clinical problem for which the optimal therapeutic strategy remains to be defined. However, renal artery stenting procedures have significantly increased as one approach to treat this clinical problem. Despite improvements in device design and technical performance of the procedure, the benefits and results of randomized clinical trials of renal artery stenting as a therapy remain confusing. Understanding the epidemiology, pathophysiology and natural history of renal artery stenosis are central to improving the outcomes of renal artery stenting. Developing both noninvasive and invasive predictive tools to better identify which patient will respond to renal revascularization will also be beneficial. In this article, we will present an overview of atherosclerotic renal artery disease. The results of renal artery stenting will be discussed and from this, the available noninvasive and invasive tools available to assess the clinical and hemodynamic significance of renal artery stenosis will be presented.
Collapse
Affiliation(s)
- Ronan Margey
- Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | |
Collapse
|
27
|
|
28
|
Chaves AAR, Buchpiguel CA, Praxedes JN, Bortolotto LA, Sapienza MT. Glomerular filtration rate measured by (51)Cr-EDTA clearance: Evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis. Clinics (Sao Paulo) 2010; 65:607-12. [PMID: 20613937 PMCID: PMC2898552 DOI: 10.1590/s1807-59322010000600008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 02/22/2010] [Accepted: 03/24/2010] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid ((51)Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using (51)Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis. METHODS This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis ((51)Cr-EDTA) and (99m)Tc-DMSA scintigraphy were performed before and after captopril administration in all patients. RESULTS The mean baseline glomerular filtration rate was 48.6+/-21.8 ml/kg/1.73 m(2) in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1+/-28.7 ml/kg/1.73m(2) in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6+/-14.8 ml/ kg/1.73m(2), p=0.001) and an insignificant change in the group without RAS (to 62.2+/-23.6 ml/kg/1.73m(2), p=0.68). Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA) did not show significant differences in differential renal function from baseline to post-captopril images in either group. CONCLUSIONS Captopril induced a decrease in the GFR that could be quantitatively measured with (51)Cr-EDTA. The reduction is more pronounced in hypertensive patients with RAS.
Collapse
|
29
|
Granata A, Fiorini F, Andrulli S, Logias F, Gallieni M, Romano G, Sicurezza E, Fiore CE. Doppler ultrasound and renal artery stenosis: An overview. J Ultrasound 2009; 12:133-43. [PMID: 23397022 DOI: 10.1016/j.jus.2009.09.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Renovascular disease is a complex disorder, most commonly caused by fibromuscular dysplasia and atherosclerotic diseases. It can be found in one of three forms: asymptomatic renal artery stenosis (RAS), renovascular hypertension, and ischemic nephropathy. Particularly, the atherosclerotic form is a progressive disease that may lead to gradual and silent loss of renal function. Thus, early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Screening for RAS is indicated in suspected renovascular hypertension or ischemic nephropathy, in order to identify patients in whom an endoluminal or surgical revascularization is advisable. Screening tests for RAS have improved considerably over the last decade. While captopril renography was widely used in the past, Doppler ultrasound (US) of the renal arteries (RAs), angio-CT, or magnetic resonance angiography (MRA) have replaced other modalities and they are now considered the screening tests of choice. An arteriogram is rarely needed for diagnostic purposes only. Color-Doppler US (CDUS) is a noninvasive, repeatable, relatively inexpensive diagnostic procedure which can accurately screen for renovascular diseases if performed by an expert. Moreover, the evaluation of the resistive index (RI) at Doppler US may be very useful in RAS affected patients for predicting the response to revascularization. However, when a discrepancy exists between clinical data and the results of Doppler US, additional tests are mandatory.
Collapse
Affiliation(s)
- A Granata
- Department of Nephrology, Dialysis and Internal Medicine, AOU Policlinico "Vittorio Emanuele", Catania, Italy
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To examine the diagnostic value of novel velocimetric colour duplex sonography indices in the screening of renal artery stenosis (RAS). METHODS We performed a retrospective analysis of all consecutively studied patients at our centre with suspected RAS, and a colour duplex sonography carried out at less than 4 months (mean 34 days) before renal angiography during a 6-year period (2002-2007). A significant RAS was defined as an at least 60% stenosis on angiography or a transstenotic mean arterial pressure gradient of at least 10 mmHg or both. RESULTS In a total of 169 patients, 111 stenotic and 206 nonstenotic kidneys were examined. The sensitivity and specificity for acceleration of blood flow in early systole (ACCmax) were 85 and 75%, respectively, and for the acceleration index (ACCmax/peak systolic velocity, AImax) 83 and 79%, respectively. Corresponding values in patients with estimated glomerular filtration rate of less than 30 ml/min/1.73 m2 were 90 and 73% (for ACCmax) and 74 and 88% (for AImax). In addition, the transstenotic mean arterial pressure gradient showed a significant, though weak, negative correlation to ACCmax (r = -0.26, P = 0.02) and AImax (r = -0.29, P = 0.01) in stenotic kidneys. CONCLUSION ACCmax and AImax provide similar, good diagnostic accuracy in the detection of a haemodynamically significant RAS, even in patients with markedly reduced glomerular filtration rate. Presumably, the lack of superiority of the novel index AImax could be explained by a highly homogenous methodological approach in the present single-centre study.
Collapse
|
31
|
Gao J, Li JC, Xiao MS, Ng A, Trost D, Goldstein M, Kapur S, Wang J, Serur D, Dai Q, Jiang YX, Min RJ. Color duplex sonography in severe transplant renal artery stenosis: a comparison of end-to-end and end-to-side arterial anastomoses. Clin Imaging 2009; 33:116-22. [PMID: 19237054 DOI: 10.1016/j.clinimag.2008.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS, arterial lumen reduction >80%) with end-to-end (EE) arterial anastomosis and that with end-to-side (ES) arterial anastomosis. METHODS We retrospectively reviewed color duplex sonography (CDUS) and digital subtraction angiography (DSA) images in 38 patients with severe TRAS (19 cases with EE and 19 cases with ES) between January 1, 2000, and December 31, 2006. Doppler parameters were analyzed, including peak systolic velocity (PSV) in the iliac artery, PSV at the arterial anastomosis, PSV in the transplant renal artery, PSV ratio of the stenotic artery/artery proximal to the stenosis, and acceleration time (AT) in the artery distal to the stenosis (in the intrarenal artery). All 38 cases with severe TRAS were initially diagnosed with CDUS and confirmed by DSA. RESULTS There were significant differences in PSV in the stenotic artery (P<.01), PSV in the iliac artery (P<.001), and PSV ratios of stenotic artery/artery proximal to the stenosis (P<.001) between arterial anastomosis of EE and that of ES. There was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis (P>.05). CONCLUSION Significantly different PSVs in the stenotic artery, the iliac artery, and the PSV ratio between EE and ES arterial anastomoses should be considered in the interpretation of CDUS when screening for severe TRAS. Different criteria of CDUS need to be established depending on the type of arterial anastomosis in order to improve the accuracy in diagnosing severe TRAS.
Collapse
Affiliation(s)
- Jing Gao
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Sechi LA, Di Fabio A, Bazzocchi M, Uzzau A, Catena C. Intrarenal hemodynamics in primary aldosteronism before and after treatment. J Clin Endocrinol Metab 2009; 94:1191-7. [PMID: 19141581 PMCID: PMC2682479 DOI: 10.1210/jc.2008-2245] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
CONTEXT Elevated urinary albumin excretion has been reported in primary aldosteronism and might partially reflect reversible abnormalities initiated by glomerular hyperfiltration. OBJECTIVE The aim of the study was to examine the outcome of renal function and intrarenal Doppler velocimetric indices in primary aldosteronism. DESIGN We conducted a prospective study of patients with primary aldosteronism who were reevaluated 1 yr after either adrenalectomy or treatment with spironolactone. SETTING The study was conducted at a university referral center. PATIENTS Fifty-four patients with tumoral or idiopathic aldosteronism were followed after either surgical (n = 24) or medical (n = 30) treatment. Patients with primary aldosteronism were compared with 100 patients with primary hypertension and comparable severity and duration of disease. MAIN OUTCOME MEASURES Changes in renal function and intrarenal echo-Doppler indices were measured. RESULTS Patients with primary aldosteronism had greater creatinine clearance and urinary albumin excretion than patients with primary hypertension. Patients with primary aldosteronism and creatinine clearance above the median (105 ml/min per 1.73 m(2)) had significantly lower resistance and pulsatility index than patients with creatinine clearance below the median, independent of disease subtype. After 1 yr, creatinine clearance and albuminuria declined, and resistance and pulsatility index increased to the same extent in patients with primary aldosteronism treated with either adrenalectomy or spironolactone. Changes in glomerular filtration and albuminuria were inversely related with baseline values of the resistance index. In primary hypertension, echo-Doppler velocimetric indices did not change during follow-up. CONCLUSIONS In primary aldosteronism, sonographic evidence of decreased intrarenal vascular resistance is associated with glomerular hyperfiltration. Both adrenalectomy and spironolactone revert the intrarenal hemodynamic pattern and decrease urinary protein losses.
Collapse
Affiliation(s)
- Leonardo A Sechi
- Department of Experimental and Clinical Pathology, Division of Internal Medicine, University of Udine, Udine, Italy.
| | | | | | | | | |
Collapse
|
33
|
Rodríguez Jornet A. Tratamiento de la nefropatía isquémica. Med Clin (Barc) 2007; 128:572-4. [PMID: 17462195 DOI: 10.1157/13101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|