Stephen Bird

Hi Merrin,

1: I do look for accessories and find them easy enough to see on the right side as I look for the renal arteries under the IVC as an isolation plane. On the left I think I miss most of them !

If I find one I try to assess it, especially at the origin.

2: I see people trying to obtain their intra-renal waveforms really peripherally in the renal cortex area and I think this is just making life hard for yourself. I do mine in the interlobar arteries more centrally in the kidney. If you think about it, if there is a stenosis in the renal artery origin that you can not see due to gas etc the acceleration time will be increased at all points distal to the stenosis so you don’t need to be in some tiny peripheral vessel to make the diagnosis. If you go too peripherally the signal to noise ration is poor and the resulting waveform being of poor quality will give you a false positive diagnosis !
3: Also with intra-renal RI the same applies, if the cortex has disease the RI will be increased in the interlobar arteries so again don’t go too peripheral.


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