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Intravenous digital subtraction renal angiography (DSRA) has been compared with conventional angiography only in small, selected series of hypertensive patients. The authors prospectively examined with intravenous DSRA 94 patients at increased risk for renovascular hypertension and compared these studies with conventional angiography. A stenosis of at least one main renal artery was identified with intravenous DSRA in 22 patients and confirmed in 20 patients. No significant stenoses were seen with conventional angiography in any of the 64 patients in whom lesions were not seen with intravenous DSRA. Since inadequate DSRA studies were considered positive for renal artery stenosis, the sensitivity of intravenous DSRA was 100% (25 of 25); specificity, 93% (64 of 69); positive predictive value, 83% (25 of 30); and negative predictive value, 100% (64 of 64). The authors conclude that intravenous DSRA is a sensitive test for identifying stenosis of the main renal arteries and is appropriate to use as a screening test among patients at increased risk for renovascular hypertension.

Intravenous digital subtraction renal angiography (IV-DSRA) is frequently used in the preoperative evaluation of living-related (LR) kidney donors. However, the true accuracy of IV-DSRA in the donor population is difficult to assess since abnormalities of the kidney and its circulation are uncommon in this group. Therefore, we evaluated IV-DSRA in a group of patients more likely to have anomalies and abnormalities that would affect LR donor selection, donor nephrectomy, and subsequent transplantation. Hypertensive adults being evaluated for renovascular hypertension had IV-DSRA and conventional renal arteriograms, which were interpreted independently. We determined the accuracy of IV-DSRA, compared with conventional arteriography, in detecting multiple renal arteries, renal artery stenosis, fibromuscular dysplasia, and abnormal renal parenchyma. Technically unsatisfactory studies were excluded from analysis. Of 59 patients evaluated, 37 had abnormalities or anomalies. IV-DSRA failed to detect 28 of 50 findings in these 37 patients. In 21 patients with multiple renal arteries, IV-DSRA underestimated the number of main renal arteries in 8. Significant renal artery stenosis, present in 16 patients, was undetected by IV-DSRA in 3 of these patients. Mild fibromuscular dysplasia was not detected by IV-DSRA in any of the 5 patients with this condition, and abnormalities of renal parenchyma were not detected in 6 of the 8 patients with scarred or cystic kidneys. When compared with conventional renal arteriography in a hypertensive population, the IV-DSRA does not accurately detect abnormalities of the kidney and its circulation. If these data are confirmed in nonhypertensive subjects, preoperative evaluation of LR kidney donors using IV-DSRA alone may fail to detect potentially important anatomic abnormalities.

Digital intravenous subtraction angiography (DISA) was used to evaluate 28 patients who had undergone renal artery reconstruction either as part of a renal transplant procedure or for treatment of renovascular hypertension. Satisfactory visualization of the renal artery was obtained in 26 cases, and the clinical questions were adequately answered in these cases. The findings included a variety of possible outcomes and demonstrate the adequacy of DISA as a means of evaluating the results of renal artery surgery. Technical and anatomic factors affecting the quality of the examination are discussed. The cases also illustrate the critical importance of thorough familiarity with the surgical procedures in general and of mutual discussion between surgeon and radiologist in optimizing the DISA examination in a given patient.

Intravenous digital subtraction angiography (IV-DSA) was compared with conventional arteriography (CA) in 14 patients with fibromuscular dysplasia (FMD) of at least one renal artery. IV-DSA identified 29 of the 34 renal arteries detected by CA. A diagnostic quality IV-DSA examination was obtained in 23 of 29 renal arteries (78%). In adequately imaged renal arteries, IV-DSA correctly identified 12 of 20 FMD renal arteries, misdiagnosed 8 FMD renal arteries as normal and correctly identified 3 normal renal arteries. These poor results, due to poor spatial resolution and subtraction artifacts inherent in the IV-DSA system, warrant careful interpretation of negative examinations and further evaluation of high risk patients.

Intravenous digital subtraction angiography (DSA) was performed in 23 patients with renal masses to document tumor extension into the main renal vein or inferior vena cava. The DSA findings were compared with computed tomographic as well as surgical and pathologic findings. Additional data regarding the number of renal arteries present and the relative vascularity of the tumor were also gathered. DSA documented 17 true-negative renal veins, three true-positive renal veins, and one false-negative renal vein. Two patients could not hold their breath long enough to evaluate the renal vein. In 17 of 19 cases, single renal arteries to the affected kidney were correctly identified. In three patients, two renal arteries to the involved kidney were correctly identified. The renal masses were avascular in two patients, hypovascular in five, moderately vascular in eight, and hypervascular in seven. In one case the mass was out of the field of view, and vascularity was not evaluated. In these patients, DSA was an accurate and relatively noninvasive method to assist in the preoperative evaluation of renal masses.