Is it necessary to study accessory arteries when screening the renal arteries for renovascular hypertension?

PURPOSE: To determine the prevalence of isolated hemodynamically significant stenoses of accessory renal arteries when the main renal arteries are patent. MATERIALS AND METHODS: In 68 adults (24 men, mean age, 67 years +/-10; 44 women, mean age, 67 years +/-12), angiograms that fulfilled the following criteria were studied: (a) technically adequate renal angiograms obtained to evaluate suspected renovascular hypertension and (b) angiographically documented hemodynamically significant stenosis of any renal artery. The percentage of kidneys and the percentage of patients with hemodynamically significant isolated stenoses of accessory renal arteries were calculated. RESULTS: Eighty-seven kidneys in 68 patients had hemodynamically significant renal artery stenoses. Fifteen kidneys had 16 accessory renal arteries. Four accessory arteries in three patients had hemodynamically significant stenoses. Only one of 68 patients (1.5%) had an accessory artery stenosis unaccompanied by a main renal artery stenosis in either kidney, this patient had bilateral hemodynamically significant accessory artery stenoses. Two patients had coexistent hemodynamically significant stenoses of accessory and main renal arteries. CONCLUSION: The prevalence of a hemodynamically significant stenosis isolated to an accessory renal artery was 1.5% in our study. Thus, failure to detect accessory renal arteries should not unduly affect the utility of a noninvasive test for detecting renovascular hypertension.