Early duplex predicts restenosis after renal artery angioplasty and stenting

• Published in: Journal of vascular surgery 2012-11, Vol.56 (5), p.1373-1380
• Main Authors: Christie, Jason W., MD, Conlee, Thomas D., MD, Craven, Timothy E., MSPH, Hurie, Justin B., MD, Godshall, Christopher J., MD, Edwards, Matthew S., MD, Hansen, Kimberley J., MD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Biological and medical sciences; Cardiovascular system; Combined Modality Therapy; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Predictive Value of Tests; Recurrence; Renal Artery Obstruction - therapy; Retrospective Studies; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Ultrasonic investigative techniques; Ultrasonography, Doppler, Duplex; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.05.067

Objective To examine the relationship between early renal duplex sonography (RDS) and restenosis after primary renal artery percutaneous angioplasty and stenting (RA-PTAS). Methods Consecutive patients undergoing RA-PTAS for hemodynamically significant atherosclerotic renal artery stenosis with hypertension and/or ischemic nephropathy between September 2003 and July 2010 were identified from a prospective registry. Patients had renal RDS pre–RA-PTAS, within 1 week of RA-PTAS and follow-up RDS examinations after the first postoperative week for surveillance of restenosis. Restenosis was defined as a renal artery peak systolic velocity (PSV) ≥180 cm/s on follow-up RDS. Associations between RDS and restenosis were examined using proportional hazards regression. Results Eighty-three patients (59% female; 12% nonwhite; mean age, 70 ± 10 years; mean pre–RA-PTAS PSV, 276 ± 107 cm/s) undergoing 91 RA-PTAS procedures comprised the sample for this study. All procedures included a completion arteriogram demonstrating no significant residual stenosis. Mean follow-up time was 14.9 ± 10.8 months. Thirty-four renal arteries (RAs) demonstrated restenosis on follow-up with a median time to restenosis of 8.7 months. There was no significant difference in the mean PSV pre–RA-PTAS in those with and without restenosis (287 ± 96 cm/s vs 269 ± 113 cm/s; P = .455), and PSV pre–RA-PTAS was not predictive of restenosis. Within 1 week of RA-PTAS, mean renal artery PSV differed significantly for renal arteries with and without restenosis (112 ± 27 cm/s vs 91 ± 34 cm/s; P = .003). Proportional hazards regression analysis demonstrated increased PSV on first post–RA-PTAS RDS was significantly and independently associated with subsequent restenosis during follow-up (hazard ratio for 30 cm/s increase, 1.81; 95% confidence interval, 1.32-2.49; P = .0003). There was no difference in pre- minus postprocedural PSV in those with and without restenosis on follow-up (175 ± 104 cm/s vs 179 ± 124 cm/s; P = .88), nor was this associated with time to restenosis. Best subsets model selection identified first postprocedural RDS as the only factor predictive of follow-up restenosis. A receiver-operating characteristic curve was examined to assess the first week PSV post–RA-PTAS most predictive of restenosis during follow-up. The ideal cut point for RA-PSV was 87 cm/s or greater. This value was associated with a sensitivity of 82.4%, specificity of 52.6%, and area under the receiver-operating characteri