ESPN 51th Annual Meeting

ESPN 2018


 
Doppler ultrasound versus digital subtraction angiography in detecting renovascular cause of arterial hypertension in children – single center experience
RINA R RUS 1 TANJA KERSNIK LEVART 1 DAMJANA KLJUčEVšEK 2 TOMAž KLJUčEVšEK 3

1- DIVISION OF PEDIATRICS LJUBLJANA, DEPARTMENT OF NEPHROLOGY
2- DIVISION OF PEDIATRICS LJUBLJANA, RADIOLOGY DEPARTMENT
3- INSTITUTE OF RADIOLOGY LJUBLJANA
 
Introduction:

Purpose of our study was to assess the accuracy of Doppler ultrasound (US) compared to digital subtraction angiography (DSA) in detecting renovascular cause of arterial hypertension in children.

Material and methods:

 

A retrospective review of 20 children with suspected renovascular cause of arterial hypertension was performed between October 2010 and October 2017 in University Children’s Hospital, Slovenia. Doppler US and DSA were performed in all children. Doppler US was defined as positive and suggested renovascular disease when turbulence was seen on color Doppler, changes of blood velocity were noticed at the site of suspected renal artery stenosis and when tardus parvus spectral Doppler pattern or other pathological renal flow parameters were recorded. Renal length discrepancy can be present. 

Results:

 

7 boys and 13 girls (3 months - 17 years) were referred to our hospital due to hypertensive urgency (2/20), hypertensive emergency (1/20), stage 2 (15/20) and stage 1 hypertension (2/20). 15 cases were suspected for renovascular disease according to Doppler US.  DSA showed unilateral or bilateral stenosis in 10 (50%) children, four of them had mid-aortic syndrome with stenosis of aorta and stenosis of some other branches of aorta.  There was also a defect of vascularization in one of lobar arteries in two children and thrombosis of renal artery and arteriovenous malformation in one child each. One child had occlusion of abdominal aorta. The sensitivity of renal Doppler US compared with DSA was 60%, whereas specificity was 85%.

Conclusions:

 

In children with clinical suspicion of renovascular disease Doppler US is usually the first investigation to perform because it is easy accessible and harmless but also highly operator dependent and should be performed by experienced person. However, according to our results DSA still remains the gold standard in detecting renovascular disease in children. The main advantage is that endovascular treatment could be done in the same session.