Renal Angiography and Angioplasty

Here is a descending aortogram with pigtail catheter showing both renal arteries arising from the aorta. Left renal artery shows narrowing in the proximal segment just after the ostium. Selective renal angiograms can be obtained by introducing either a Judkins right coronary catheter or a cobra catheter into the renal artery ostium and gently injecting contrast to fill the renal arteries.
The imaging is continued till the nephrogram phase is obtained. It may be better to do selective angiograms after locating the renal arteries by non-selective aortograms as in this case. This will help to identify multiple renal arteries if present. If multiple renal arteries are present and
stenotic, the option may be in favour of surgical correction rather than catheter based intervention.
Once the renal arterial anatomy has been documented, one may proceed with interventions if the
stenosis is severe and angioplasty indicated. In  general renal angioplasty is considered
only for lesions which produce uncontrolled hypertension or deterioration of renal function. Angioplasty is seldom done for lesions incidentally detected during angiography for atherosclerotic
lesions elsewhere. Recurrent flash pulmonary edema known as Pickering syndrome, is an important indication for renal angioplasty. The reason for restrictive use of angioplasty is the lack of evidence regarding benefit from angioplasty of incidentally detected renal artery stenosis.
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