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Duplex Scanning of Renal Arteries for Stenosis
- Richard G. Appel, MD;
- Anthony J. Bleyer, MD; and
- Kimberley J. Hansen, MD
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TO THE EDITOR:
In their recent report, Olin and colleagues ([1]) state that a renal artery end diastolic velocity of 150 cm/sec or greater is an important criterion for diagnosing critical renal artery stenosis. This appears to be correct; however, for an end diastolic velocity of 150 cm/sec to have a high clinical utility, values less than 150 cm/sec should be helpful in identifying arteries that lack critical stenosis. Figure 3 of Olin and colleagues' report shows that this is clearly not the case ([1]). Several investigators have shown that end diastolic velocity correlates inversely with serum creatinine levels ([2]). Therefore, with significant renal parenchymal disease, end diastolic velocity may be reduced, even in the presence of critical renal artery stenosis. It is important to identify these patients, given that a low end diastolic velocity does not preclude beneficial blood pressure or renal function response in patients having revascularization ([2]). We recently reported that renal artery stenosis commonly occurs in older patients who are beginning renal replacement therapy ([3]). In these patients, end diastolic velocity was successfully measured in 80 consecutive nonoccluded arteries. The results are shown in Table 1. Although arteries with critical renal artery stenosis had a significantly higher end diastolic velocity than arteries without critical stenosis, overall end diastolic velocity was low. Peak systolic velocity was greater than 200 cm/sec in all arteries with critical stenosis and less than 200 cm/sec in all arteries without critical stenosis. In summary, an end diastolic volume of greater than 150 cm/sec may not be a highly useful criterion to identify critical renal artery stenosis because critical stenoses frequently occur with an end diastolic velocity of less than 150 cm/sec.
Richard G. Appel, MD
Anthony J. Bleyer, MD
Kimberley J. Hansen, MD
Bowman Gray School of Medicine
Winston-Salem, NC 27157
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
