Pharmacoangiographic manipulation of renal collateral blood flow.

Vasodilatory or vasoconstrictive renal pharmacoangiography was applied in investigating the significance of 50 renal artery stenoses. The technique involves comparison of selective magnification renal arteriograms before and after intra-arterial injection of epinephrine or acetylcholine, seeking changes in direction of flow in potential collateral routes. The drug injected depended upon the hemodynamic conditions during control arteriography. Final determination of significance depended on response to surgery in most patients, and renin levels in a few. Vasoconstrictive angiography was determinate in 18/26 (69%) of significant stenoses and correctly identified hemodynamic significance in each. Other angiographic signs of collateral circulation were present in seven of the other eight significant stenoses studied with the vasoconstrictive method. Vasodilatory pharmacoangiography was determinate in 20 arteries, and correctly evaluated each of nine significant and 11 insignificant lesions. Pharmacoangiography is a moderately sensitive and completely specific angiographic method for evaluating the hemodynamic significance of renal artery stenoses.