Fournier A, Cécile J P, Makdassi R, Fievet P, Bataille P, Remond A, Grumbach Y
Nephrologie. 1981;2(1):15-9.
The authors review the various techniques of intravenous arteriography before an excretory urogram and discuss their role in the etiological diagnosis of hypertension. Detection of renovascular disease classically implied Seldinger arteriography, with its limited indications, because of side effects and cost. This classical approach should now be systematically replaced by the visualization of renal arteries during the intravenous pyelography procedure which appears to be a method more effective, as well as less expensive and hazardous. The pyelogram wash-out should still be performed when the visualization of the renal arteries is poor because of its value in the screening for renovascular hypertension. Furthermore, when a renal artery stenosis is clearly defined, the wash-out of the pyelogram should also be performed because of its prognostic value. As the classical approach for the etiological diagnosis of hypertension, this technique has limited indications. It is indicated in severe hypertension in the young, when medical treatment does not control blood pressure satisfactorily or when renal failure progresses rapidly. Furthermore, this technique allows a non traumatic follow up of operated or dilated stenoses.
作者回顾了排泄性尿路造影前的各种静脉动脉造影技术，并讨论了它们在高血压病因诊断中的作用。经典的肾血管疾病检测方法是Seldinger动脉造影，但由于其副作用和成本，其适应证有限。现在，这种经典方法应系统地被静脉肾盂造影过程中肾动脉的可视化所取代，后者似乎是一种更有效、成本更低且风险更小的方法。当肾动脉显影不佳时，仍应进行肾盂造影冲洗，因为其在肾血管性高血压筛查中有价值。此外，当明确诊断出肾动脉狭窄时，也应进行肾盂造影冲洗，因为其具有预后价值。作为高血压病因诊断的经典方法，该技术适应证有限。适用于年轻患者的重度高血压，当药物治疗不能令人满意地控制血压或肾衰竭迅速进展时。此外，该技术还可对手术或扩张后的狭窄进行无创随访。
