I agree that one must do a complete renal 2D evaluation and a complete renal artery doppler. From my perspective, one should perfom a full direct visualization of the Renal arteries, a complete upper-mid-lower pole segmental indirect evaluation to include both an acceleration time < .075 seconds and a RI as well as presence for the Early Systolic Peak (esp). Evalauting the overall mechanical presentaion of the renal anatomy, intrinsic flow and extrinsic flow is the only way to go. Anything less. imo, is falling short of the complete picture.
At times, we find an almost hemodnynamically significant stenosis with a morphed presentation of the ESP, in this case we feel that there is RAS but it may be in the 40-60% range. Regardless of this, the phsyicians will almost always do an angio with the predication of performing revascularization, even if it is < 60% which literature indicates is the cause for RAS in most presentations.
What if the esp is morphed, the velocity is just below 180 cm/sec with a ratio say 2.4, and an acceleration time just below .075 seconds. In this case the patient would have RAS, but on the verge of being hemodynamically significant. Duplex ultrasound can always predict almost any stage of RAS imo.
For us, complete study, means complete study, we interrogate the entire
vessel as long as we can see it, just because be see an ostial stenosis we
don't stop there, as there may also be stenosis in the mid or distal portion of
the vessel, it would be a shame if the interventionalist opened the proximal
artery and missed a more distal lesion.
On Wed, 5 May 2010 21:07:37 -0500, Norman Paley <[log in to unmask]>
>After a conversation that I had today with a general ultrasound technologist
I have a question. Does anybody here who does renal artery Doppler studies
consider the study for that kidney completed and stop upon determining that
the renal/aortic ratio is > 3.5, or, do you continue and try to get all of the
additional data and views that are generally obtained in a complete renal
artery study? Thank you for any response.
>Norman Paley, BS, RVT
>Technical Director Vascular Laboratory
>Richmond University Medical Center
>Staten Island, New York
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