Renal artery stenosis with incidental mesenteric artery stenosis
Presentation
History of hypertension, poorly controlled by medication until recently.
Patient Data
The aortic waveforms were normal with no evidence of cardiac arrhythmia.
Right renal artery peak systolic velocity was slightly elevated at the origin. The velocity ratio is 2.36.
Right renal artery peak systolic velocity was slightly elevated proximally. The velocity ratio is also elevated at 3.72.
Right renal artery peak systolic velocity was slightly elevated at the mid-segment. The velocity ratio is 2.48. Distally, the velocities were within normal limits as were hilar waveforms, acceleration times and acceleration indices (not shown).
The right kidney appears to be morphologically normal. However, there has been a progressive decrease in length. It measured 11.7 cm in 18 months earlier and 10.2 cm 18 months earlier.
There is a mild increase in peak systolic velocity at the origin of the left renal artery. The velocity ratio is 2.24.
Increased peak systolic velocities extended into the proximal left renal artery. Here the velocity ratio was 1.70. Distally, the velocities were within normal limits as were hilar waveforms, acceleration times and acceleration indices (not shown).
The left kidney appears to be morphologically normal. However, the length of the kidney as measured in half a year earlier (10.3 cm) and in this exam is less than on a newer exam done half a year later (12.1 cm).
Aliasing was noted within the celiac axis and proximal superior mesenteric artery and peak systolic velocities suggest a >70% stenosis in both.
Case Discussion
Bilateral renal artery stenoses of <60% were identified in a renal artery ultrasound several years earlier. The stenoses were also graded at <60% on a surveillance ultrasound the following year. This surveillance ultrasound was performed half a year later.
Elevated peak systolic velocities and velocity ratios in the right renal artery suggesting stenosis greater than 60%. The stenosis extends from the origin to the mid-segment. Progressive decrease in length of the right kidney over 1.5 years.
Elevated peak systolic velocities in the left renal artery with velocity ratios within normal limits suggesting a <60% stenosis from the origin to the proximal segment. Variable length measurements of the left kidney.
>70% stenoses of the celiac axis and superior mesenteric artery.
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