Intraoperative renal duplex sonography: A valuable method for evaluating renal artery reconstructions

Abstract

Objectives: To determine the ability of duplex sonography to intraoperatively detect technical problems with renal artery reconstructions. Design: Retrospective evaluation of a standard protocol. Patients and methods: The outcome of intraoperative duplex was compared with postoperative angiography, surface duplex, MRA, echo or direct inspection in case of re-exploration in 77 renal artery reconstructions in 62 patients. These included six extracorporeal reconstructions, eight and 17 reconstructions with an artery and autogenous vein respectively, 10 renal artery re-implantations in the aorta (prosthesis), 32 endarterectomies and four reconstructions of kidney transplant vessels. Results: Intraoperative duplex was normal in 67/73 reconstructions with sufficient data. In six cases technical problems were revealed by intraoperative duplex and the reconstruction was re-explored. After re-exploration intraoperative duplex was normal in all cases. Confirmatory studies demonstrated normal results in 61/64 reconstructions with normal intraoperative duplex and abnormal results in 6/6 reconstructions with technical problems revealed by intraoperative duplex. Three reconstructions with normal intraoperative duplex occluded as demonstrated by angiography less than 2 weeks after surgery. Conclusions: Renal duplex sonography is a valuable method available for intraoperative detection of technical problems. Haemodynamic duplex data were less important than B-mode imaging in discriminating between normal and abnormal reconstruction.