Digital Substraction Angiography

            Digital subtraction angiography using IV contrast injection enjoyed brief popularity as a screening test for renal artery stenosis, but most centers have abandoned this technique for more modern imaging.
           Direct injection angiography is the gold standard used in evaluating the main and accessory renal arteries. Angiography is often preferred in patients with fibromuscular dysplasia. One should keep in mind that hypertension, in general, is associated with arterial vasospasm and tortuosity of intrarenal arteries.
            Carbon dioxide can be used in place of iodinated contrast to evaluate renal arteries during digital subtraction arteriography. In patients at risk for contrast-related nephrotoxicity or who are allergic to iodinated contrast, carbon dioxide arteriography appears to be a viable alternative.
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Radiology images of the left renal artery stenosis (arrow) in a hypertensive
patient. A stent was later inserted.
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Radiology images of the renal arteriogram in a woman with renal failure, malignant hypertension and scleroderma reveals marked vasospasm and tortuosity of major and smaller intrarenal vessels. The distal intrarenal arteries are tapered. Vasospasm resulted in slow intrarenal flow and persistence of arterial filling. Similar changes are found both in renovascular hypertension and in scleroderma.
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