Doppler Sonographic Criteria for the Diagnosis of Inferior Mesenteric Artery Stenosis

Pellerito, John S.; Revzin, Margarita V.; Tsang, James; Greben, Craig; Naidich, James B.

doi:10.7863/jum.2009.28.5.641

Cited by 33 publications

(20 citation statements)

References 23 publications

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“…A fasting peak systolic velocity of > 275 cm/sec predicts a 70% or greater angiographic stenosis with a sensitivity of 92% and a specificity of 96% [11]. More recently, specific DUS criteria for IMA stenosis has been established for defining a > 70% stenosis in this vessel with a peak systolic velocity > 200 cm/sec, end‐diastolic velocity > 25 cm/sec, and mesenteric to aortic velocity ratio > 2.5 [12]. DUS, however, is inconclusive in up to 10%, and, in these cases, CT angiography and gadolinium‐enhanced MRA are useful adjunctive studies [13].…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: A paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia

Lotun

Shetty

Topaz

2012

Cathet Cardio Intervent

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Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia.

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Section: Discussionmentioning

confidence: 99%

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: A paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia

Lotun

Shetty

Topaz

2012

Cathet Cardio Intervent

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“…The most commonly used duplex criteria for significant visceral disease are for the celiac trunk a peak systolic velocity greater than 200 cm/s or superior mesenteric artery peak systolic velocity greater than 275 cm/s. [17][18][19][20][21] CT-angiography and gadolinium-enhanced MR-angiography are useful initial tests for supporting the clinical diagnosis of symptomatic CMI if duplex ultrasound is inconclusive (as in approximately 10% of the cases due to bowel gas shadowing effects). [22][23][24][25][26][27] CMI can be diagnosed by a test for actual ischemia.…”

Section: Diagnostic Strategymentioning

confidence: 99%

Chronic atherosclerotic mesenteric ischemia (CMI)

2010

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Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of, in most conditions, at least two visceral arteries. If only one of the three major bowel-providing arteriesthe celiac trunk, and the superior and inferior mesenteric arteries -is affected, the patient is usually asymptomatic due to a tight collateral network. The only exception is the celiac artery compression syndrome which represents primarily a compression syndrome of celiac plexus nerves by the arcuate ligament in conjunction with a compression of the celiac trunk. CMI of atherosclerotic origin is associated with a high morbidity and mortality. During the last decade, endovascular revascularization has replaced surgical revascularization as the therapy of choice in most centers. This article reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.

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“…The method seems suitable both for screening and follow up studies [14,15]. Velocity criteria for at least 70% stenosis for all the large mesenteric vessels are well established in comparison to angiography [3,13,16].…”

Section: Discussionmentioning

confidence: 99%

“…The use of Duplex scanning was first described in the mid 1980´s and may be used as a screening method to detect the presence of mesenteric stenosis, both on the 2D image and with Doppler flow detection [2,3,8].…”

Section: Introductionmentioning

confidence: 99%

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Postprandial Evaluation of Possible Collateral Pathways in Chronic Mesenteric Ischemia with Duplex Ultrasound

Zachrisson¹

2014

J Med Diagn Meth

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Objective: Duplex scanning may be used to detect high-grade stenoses in the mesenteric vessels in patients with suspect Chronic Mesenterial Ischemia (CMI). The aim of the study was to evaluate reserve and collateral vascular function in relation to bowel symptoms in patients with CMI. Methods:Fourteen consecutive patients, referred to the vascular laboratory with suspicion of CMI, 7 men (average 79 years), and 7 women (average 66 years), were investigated by Duplex ultrasound (DUS) of the visceral arteries. All patients were examined both fasting and 30 min after a standard meal. A reference group of 10 patients with diffuse bowel symptoms (5 men and 5 women, (average 75 years) were investigated by the same DUS protocol, all showing normal mesenteric arteries. Possible collateral reserve capacity was defined as a marked increase of flow velocities (>20%) in vessels with lesions and/or in non-affected vessels.Results: All patients had a significant stenosis (>70%) in one or several visceral arteries at the baseline DUS investigation. Six patients had abdominal pain after the test meal, whilst 8 patients experienced no pain. In patients without postprandial pain a possible collateral reserve capacity was detected. In this group superior mesenteric artery (SMA) peak systolic velocity (PSV) increased significantly (baseline PSV 2.6 ± 1.3 m/s vs. postprandial PSV 4.1 ± 1.6 m/s, P < 0.05) whereas patients with postprandial pain showed no signs of collateral reserve capacity in any vessel except one patient who showed possible collateral reserve in one vessel. In the reference group a significant increase of PSV was seen in SMA only, (1.7 ± 0.6, vs. 2.5 ± 0.9, P < 0.05). Conclusion:Postprandial duplex adds information about the functional flow limitation of the stenosis and possible collateral reserve flow capacity. Further studies have to be performed to establish criteria for selection of patients appropriate for intervention.

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Doppler Sonographic Criteria for the Diagnosis of Inferior Mesenteric Artery Stenosis

Abstract: We found that a PSV of greater than 200 cm/s was the best criterion for the diagnosis of IMA stenosis. The sensitivity, specificity, PPV, NPV, and accuracy for the PSV were 90%, 97%, 90%, 97%, and 95%, respectively.

Cited by 33 publications

References 23 publications

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: A paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: A paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia

Chronic atherosclerotic mesenteric ischemia (CMI)

Postprandial Evaluation of Possible Collateral Pathways in Chronic Mesenteric Ischemia with Duplex Ultrasound

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