Renovascular arterial hypertension. Importance of subtraction digital angiography in its diagnosis

The authors describe the material and the use method of intravenous digital subtraction angiography (IVDSA) before presenting the obtained results. The morphologic abnormalities of the renal arteries evidenced in 105 patients, are distributed by different pathologies such as: atherosclerosis 48 patients; fibromuscular dysplasia 27 patients; Takayasu's aortoarteritis 8 patients (7.6%); renal artery aneurysms 5 patients (4.8%); renal arterial emboli 1 patient (0.9%); iatrogenic 6 patients (5.7%); small kidney/hypoplastic renal artery 10 patients (9.5%). The authors draw also attention to an anatomic variant-the early bifurcation of the renal artery that should be evaluated under the pathophysiologic point of view. From this experience some conclusions emerge. The IVDSA permits the ambulatory screening of the renal arteries abnormalities with additive value in the cost/benefit ratio, that is translated in the increasing number of hypertensive patients who are identified as having renal artery abnormalities. The pathologies more frequently identified are the atherosclerotic in the old male and the fibromuscular dysplasia in the young female. The pathophysiologic significance of the early bifurcation of the renal artery needs further elucidation. According to the authors experience, the IVDSA has a paramount position and can even be the first test to be performed in the workup diagnostic approach to the hypertensive patient with moderate and strong suspection of RVH.