Renal Artery Stenosis Rather Than Term Paper

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CT scan or MRA may result in the clinician oversight of some of the more subtle findings. It is expensive and the availability is limited.

It is possible to evaluate RAS via angiogram, bet evaluation of the size of the stenosis tends to be imprecise. Additionally, angiography does not allow a cross-sectional assessment of the stenosis, and in the case of FMD, it is not possible to distinguish the different histological types, although intervention at the time of assessment is a possibility. Doppler sonography is able to measure the amount of blood flow, and is non-invasive. It tends to be highly invasive and is able to demonstrate problems with slow patterns and other issues which are highly suggestive of significant stenosis. Doppler ultrasound tends to be very operator dependent and the exam takes a significant amount of time. Additionally, the exam may be limited by abdominal girth, patient movement and other physical pathology.

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In a recent study from Australia (Paven et.al. 2006); screening tests were evaluated in regards to accuracy and efficacy of application to large scale clinical practice. This study showed that 24% of all patients who were diagnosed with RAS had no screening intervention prior to being sent for angiography, and Duplex U.S. was the most commonly utilized screening test. Duplex screening was the second most accurate (After MRA) with a positive predictive value of 88%

Reference:

1. Paven G; Waugh R; Nicholson J; Gillin a; Hennessy a Nephrology (Carlton). 2006; 11(1):68-72

2. Agency for Healthcare Quality and Research (AHRQ)

Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: AHRQ Executive Summary,), Rockville, Maryland; http://hcup.ahrq.gov/HCUPnet.asp

3. Dejani H, Eisen TD, Finkelstein FO: Revascularization of renal artery stenosis in patients with renal insufficiency. Am J. Kidney Dis….....

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