Stenosis of the Main Artery Supplying an Organ: Effect of End-Organ Vascular Resistance on the Poststenotic Peak Systolic Velocity in an in Vitro Hydraulic Model at Doppler US
Abstract
PURPOSE: To test the hypothesis that increased end-organ vascular resistance reduces blood flow to the kidney, thus reducing the mean velocity in the renal artery and secondarily lowering the peak systolic velocity (PSV).
MATERIALS AND METHODS: An in vitro hydraulic model with a pulsatile pump, blood-mimicking fluid, interchangeable stenoses, and variable compliance and resistance was used to investigate the relationship between end-organ vascular resistance and poststenotic PSV.
RESULTS: Poststenotic PSV was mildly dependent on end-organ vascular resistance and decreased with increasing resistance.
CONCLUSION: The results help explain some of the reported variability from using poststenotic PSV to detect hemodynamically significant renal arterial stenoses, but the effect is not great enough to completely explain the variability. Other factors not investigated in this study must be at work as well.
References
- 1 Avasthi PS, Voyles WF, Greene ER. Noninvasive diagnosis of renal artery stenosis by echo-Doppler velocimetry. Kidney Int 1984; 25:824-829. Crossref, Medline, Google Scholar
- 2 Berland LL, Koslin DB, Routh WD, Keller FS. Renal artery stenosis: prospective evaluation of diagnosis with color duplex US compared with angiography—work in progress. Radiology 1990; 174:421-423. Link, Google Scholar
- 3 Desberg AL, Paushter DM, Lammert GK, et al. Renal artery stenosis: evaluation with color Doppler flow imaging. Radiology 1990; 177:749-753. Link, Google Scholar
- 4 Duda SH, Erley CM, Wakat JP, et al. Posttransplant renal artery stenosis: outpatient intraarterial DSA versus color aided duplex Doppler sonography. Eur J Radiol 1993; 16:95-101. Crossref, Medline, Google Scholar
- 5 Kliewer MA, Tupler RH, Carroll BA, et al. Renal artery stenosis: analysis of Doppler waveform parameters and tardus-parvus pattern. Radiology 1993; 189:779-787. Link, Google Scholar
- 6 Saarinen O, Salmela K, Edgren J. Doppler ultrasound in the diagnosis of renal transplant artery stenosis: value of resistive index. Acta Radiol 1994; 35:586-589. Crossref, Medline, Google Scholar
- 7 Baxter GM, Ireland H, Moss JG, et al. Colour Doppler ultrasound in renal transplant artery stenosis: which Doppler index?. Clin Radiol 1995; 50:618-622. Crossref, Medline, Google Scholar
- 8 Gottlieb RH, Lieberman JL, Pabico RC, Waldman DL. Diagnosis of renal artery stenosis in transplanted kidneys: value of Doppler waveform analysis of the intrarenal arteries. AJR 1995; 165:1441-1446. Crossref, Medline, Google Scholar
- 9 Hélénon O, El Rody F, Correas JM, et al. Color Doppler US of renovascular disease in native kidneys. RadioGraphics 1995; 15:833-854. Link, Google Scholar
- 10 Hoffmann U, Edwards JM, Carter S, et al. Role of duplex scanning for the detection of atherosclerotic renal artery disease. Kidney Int 1991; 39:1232-1239. Crossref, Medline, Google Scholar
- 11 Olin JW, Piedmonte MR, Young JR, DeAnna S, Grubb M, Childs MB. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med 1995; 122:833-838. Crossref, Medline, Google Scholar
- 12 Strotzer M, Fellner CM, Geissler A, et al. Noninvasive assessment of renal artery stenosis: a comparison of MR angiography, color Doppler sonography, and intraarterial angiography. Acta Radiol 1995; 36:243-247. Crossref, Medline, Google Scholar
- 13 Miralles M, Cairols C, Cotillas J, Gimenez A, Santiso A. Value of Doppler parameters in the diagnosis of renal artery stenosis. J Vasc Surg 1996; 23:428-435. Crossref, Medline, Google Scholar
- 14 van der Hulst VPM, van Baalen J, Kool LS, et al. Renal artery stenosis: endovascular flow wire study for validation of Doppler US. Radiology 1996; 200:165-168. Link, Google Scholar
- 15 Merkus JW, Hoitsma AJ, van Asten WN, et al. Echo-Doppler diagnosis of renal allograft artery stenosis. Clin Transplant 1995; 9:383-389. Medline, Google Scholar
- 16 Taylor DC, Kettler MD, Moneta GL, et al. Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation. J Vasc Surg 1988; 7:363-369. Crossref, Medline, Google Scholar
- 17 Hansen KJ, Tribble RW, Reavis SW, et al. Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990; 12:227-236. Crossref, Google Scholar
- 18 Kohler TR, Zierler RE, Martin RL, et al. Noninvasive diagnosis of renal artery stenosis by ultrasonic duplex scanning. J Vasc Surg 1986; 4:450-456. Crossref, Medline, Google Scholar
- 19 Halpern EJ, Needleman L, Nack TL, East SA. Renal artery stenosis: should we study the main renal artery or segmental vessels?. Radiology 1995; 195:799-804. Link, Google Scholar
- 20 Bude RO, Rubin JM, Platt JF, Fechner KP, Adler RS. Pulsus tardus: its cause and potential limitations in detection of arterial stenosis. Radiology 1994; 190:779-784. Link, Google Scholar
- 21 Folkow B, Neil E. General principles In: Circulation. New York, NY: Oxford University Press, 1971; 10. Google Scholar
- 22 Nichols WW, O'Rourke MF. The nature of flow of a fluid. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 4th ed. New York, NY: Oxford University Press, 1998; 11. Google Scholar
- 23 Nichols WW, O'Rourke MF. Introduction. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 4th ed. New York, NY: Oxford University Press, 1998; 1. Google Scholar
- 24 Nichols WW, O'Rourke MF. The nature of flow of a fluid. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 4th ed. New York, NY: Oxford University Press, 1998; 40-47. Google Scholar
- 25 Duck FA. Mechanical properties of tissue In: Physical properties of tissue. San Diego, Calif: Academic Press, 1990; 161. Google Scholar
- 26 Weast RC. Handbook of chemistry and physics: a ready-reference book of chemical and physical data 48th ed. Cleveland, Ohio: Chemical Rubber, 1967; D191-D192. Google Scholar
- 27 Gould KL. Dynamic coronary stenosis. Am J Cardiol 1980; 45:286-292. Crossref, Medline, Google Scholar
- 28 Nichols WW, O'Rourke MF. The nature of flow of a fluid. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 3rd ed. Philadelphia, Pa: Lea & Febiger, 1990; 26. Google Scholar
- 29 Norris CS, Barnes RW. Renal artery flow velocity analysis: a sensitive measure of experimental and clinical renovascular resistance. J Surg Res 1984; 36:230-236. Crossref, Medline, Google Scholar
- 30 Nichols WW, O'Rourke MF. Introduction. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 4th ed. New York, NY: Oxford University Press, 1998; 3. Google Scholar
- 31 Nichols WW, O'Rourke MF. Coupling of the left ventricle with the systemic circulation: implications to cardiac failure. In: Nichols WW, O'Rourke MF, eds. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. 4th ed. New York, NY: Oxford University Press, 1998; 295-296. Google Scholar
- 32 McDonald DA, Taylor MG. The hydrodynamics of the arterial circulation. Prog Biophys Chem 1959; 9:107-173. Google Scholar
- 33 Halpern EJ, Deane CR, Needleman L, Merton DA, East SA. Normal renal artery spectral Doppler waveform: a closer look. Radiology 1995; 196:667-673. Link, Google Scholar
- 34 Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral, and gonadal arteries. J Int Coll Surg 1958; 29:41-76. Medline, Google Scholar
- 35 Halpern EJ, Merton DA, Forsberg F. Effect of distal resistance on Doppler US flow patterns. Radiology 1998; 206:761-766. Link, Google Scholar
- 36 Westerhof N, Sipkema P, Bos GC, van den Elzinga Z. Forward and backward waves in the arterial system. Cardiovasc Res 1972; 6:648-656. Crossref, Medline, Google Scholar







