Appraisal of Arteriography in Estimating the Hemodynamic Significance of Renal Artery Stenoses

The role of arteriography in identifying renal artery stenoses is well appreciated. However, many stenoses are not of hemodynamic significance; i.e., they may not decrease blood pressure or flow in poststenotic arterial segments. This study was designed to investigate the applicability of arteriography in assessing the hemodynamic effects of renal artery stenosis. Arteriograms were analyzed in 23 hemodynamically significant renal artery stenoses. In most cases hemodynamic significance was proven by demonstration of a pressure gradient at the time of surgery. One or more arteriographic features indicating hemodynamic significance were present in 21 of the 23 lesions. All stenoses smaller than 1.5 ml diameter were hemodynamically significant. Some of greater diameter were also significant. Unilateral slowed flow was a helpful, but not totally reliable, corroboratory sign and was seen in about three-fourths of cases. Collateral circulation reliably indicated a hemodynamically significant lesion and was present in approximately two-thirds of cases. The author points out that, although a stenosis cannot be responsible for systemic hypertension unless it is of hemodynamic significance, correction of such a stenosis will not invariably produce a favorable clinical response.