A preliminary study of the role of duplex scanning in defining the adequacy of treatment of patients with renal artery fibromuscular dysplasia

Renal artery fibromuscular dysplasia is a well-known cause of hypertension whose presence is confirmed by its typical arteriographic appearance. The functional significance of these lesions is often difficult to determine, particularly when both renal arteries are involved. Duplex scanning has been shown to be accurate for the detection of renal artery stenosis and estimation of the degree of narrowing. To test whether duplex scanning results after intervention correlate with clinical outcome, we reviewed the studies on nine patients with renal artery fibromuscular dysplasia who had been treated by either angioplasty or surgery. A total of 18 arteries were treated. Fourteen of the 18 treatments were successful as measured by a reduction in blood pressure and antihypertensive drugs. In four instances treatment was unsuccessful. For those patients who had clinical improvement, the hemodynamic parameters from the renal artery also improved. In the patients for whom treatment failed, the velocities recorded from the site of narrowing did not improve after intervention. Thus it appears that duplex scanning along with the clinical results may be used to document the basis for failing to improve after treatment be it angioplasty or operation.