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Intrarenal Color Duplex Ultrasonography

A Window to Vascular Complications of Renal Transplants

Departments of Radiology (J.G., A.N., G.S., R.J.M.) and Surgery (M.G., S.K.) and the Rogosin Institute and Division of Nephrology (J.W.), New York Presbyterian Hospital–Weill Cornell Medical College, New York, New York USA.

Address correspondence to Jing Gao, MD, Department of Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center, 525 E 68th St, Starr 8A 27, New York, NY 10021 USA. E-mail: jig2001{at}med.cornell.edu

Objective. We analyze and discuss the importance of intrarenal color duplex ultrasonography (CDUS) in the diagnosis and differential diagnosis of vascular complications in renal transplants. Methods. We retrospectively reviewed results of CDUS, especially intrarenal CDUS, in 102 consecutive inpatients with vascular complications of renal transplants from January 1, 2000, to December 31, 2006. Correlations between CDUS and magnetic resonance angiography, digital subtraction angiography, surgical findings, and clinical diagnoses were studied. Results. Abnormal findings on intrarenal CDUS clearly represent vascular complications primarily located at the main renal vessels and intrarenal vessels. In our study, there were 5 cases of false-negative intrarenal arteriovenous fistulas, 1 case of false-positive transplant renal vein thrombosis, and 2 cases of false-negative transplant renal artery stenosis. The accuracy of detecting vascular complications of renal transplants with CDUS was 92% (94/102). Conclusions. Intrarenal CDUS is a noninvasive, accurate diagnostic tool that can be administrated portably and is easily repeatable, thereby making it not only a highly valuable imaging technique but also the method of choice in screening and diagnosing vascular complications of renal transplants.

Key Words: color duplex ultrasonography • renal transplants • vascular complications

Abbreviations: AI, acceleration index • AT, acceleration time • AVF, arteriovenous fistula • CDUS, color duplex ultrasonography • DSA, digital subtraction angiography • MRA, magnetic resonance angiography • PSA, pseudoaneurysm • PSV, peak systolic velocity • RI, resistive index • TRAS, transplant renal artery stenosis • TRVT, transplant renal vein thrombosis

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