Contractions of the Renal Arteries During Arteriography

Interest in renal artery disease as a cause of hypertension has resulted in the frequent use of renal arteriography in the evaluation of the hypertensive patient. Although various pathologic lesions of the renal artery have been described, the occurrence of its functional narrowing has not been generally recognized. In many instances, these contractions closely resemble fixed renal artery disease. The occurrence of contractions in various arteries has been described previously. Theander (16) reported four instances of long segments of undulating contractions observed during arteriography of the lower extremities. These he termed “stationary arterial waves.” In three of the patients arterial obstruction was distal to the waves, and in one there was an obscure vascular disease. Amplatz (2) presented a similar example of a long segment of contractions in the internal carotid artery of a patient who had occlusion of the homolateral and middle cerebral artery. Other authors (5, 6, 11, 19) have also demonstrated localized segments of arterial narrowing occurring during arteriography and related to external stimuli. These they termed “arterial spasm.” This report describes arterial contractions in 19 patients during the course of renal arteriography. Characteristics of the contractions which allow differentiation from fixed renal artery disease are presented, and the etiologic factors that may be involved are discussed. Material and Methods Renal arteriography was performed in 600 patients by selective renal artery catheterization after percutaneous introduction of a catheter into the abdominal aorta through the femoral artery by the Seldinger (15) method. The technical aspects of our method have been previously described (13). Individual radiographs were obtained after manual injection of approximately 6 ml of 50 per cent diatrizoate sodium2 into the renal arteries. Injections were repeated when the character of the lesion suggested a transient contraction. In all patients aortography was performed by pressure injection of 20 ml of from 50 to 75 per cent diatrizoate sodium into the abdominal aorta. Translumbar aortography was employed in one patient for the preoperative and immediately postoperative examinations. A subsequent study of this patient was carried out by the method described. In all but a few patients renal arteriography was performed for the evaluation of the cause of arterial hypertension. Results During renal arteriography arterial contractions were observed in the renal arteries of 19 of the 600 patients. Identification of the functional character of arterial narrowing was based upon the complete disappearance or significant modification of the contraction on subsequent arteriograms. In 15 patients these criteria were met during the initial study. In 4 patients, a second examination was required to confirm the transient character of the narrowing.