Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion

Abstract

Mesenteric artery duplex scanning appears promising for detection of splanchnic artery stenosis or occlusion or both in patients with symptoms suggestive of chronic intestinal ischemia. However, no specific duplex criteria have been developed for detection of mesenteric artery stenosis. We obtained mesenteric artery duplex scans and infradiaphragmatic lateral aortograms in 34 patients to determine duplex criteria for mesenteric stenosis. Seventy percent or greater angiographic stenosis was present in 10 superior mesenteric arteries and 16 celiac arteries. Duplex scans were reviewed to determine if celiac artery and superior mesenteric artery ratios of peak systolic velocities and end-diastolic velocities to peak aortic systolic velocity, as well as celiac artery and superior mesenteric artery peak systolic velocities and end-diastolic velocities alone, could predict a greater than or equal to 70% angiographic stenosis or occlusion or both. The results obtained by use of receiver operator curves indicated peak systolic velocity alone was an accurate predictor of splanchnic artery stenosis. Specifically, a peak systolic velocity greater than or equal to 275 cm/sec in the superior mesenteric artery and greater than or equal to 200 cm/sec in the celiac artery or no flow signal (superior mesenteric artery and celiac artery) predicted a 70% to 100% stenosis with sensitivity, specificity, and positive predictive values of 89%, 92%, and 80% for the superior mesenteric artery. Similar values for the celiac artery were 75%, 89%, and 85%, respectively. End-diastolic velocities or calculated velocity ratios conveyed no additional accuracy in predicting splanchnic artery stenosis.

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)

“…Duplex scanning of visceral vessels is technically difficult but can be accomplished in more than 85% of subjects in the elective setting. The test has an overall accuracy of approximately 90% for detection of greater than 70% diameter stenoses or occlusions of the celiac and superior mesenteric arteries when performed in highly experienced laboratories (837)(838)(839). Although the expected increase in intestinal arterial flow that results from food ingestion can be detected and quantified by duplex scanning, this information has not added to the diagnostic accuracy of the test for establishing whether abdominal symptoms that are present are the result of intestinal ischemia (840).…”

Median Arcuate Ligament Syndrome: A Case Report

“…On deep expiration, the PSV in the vessel increased to 385 cm/sec ( Figure 5B). It was noted, however, that the PSV returned to a normal velocity of 121 cm/sec on deep inspiration, indicating a <70% stenosis 6 ( Figure 5C). Also of interest was the change in the angulation of the CA with respiration and the subsequent change in Doppler angle necessary to remain parallel to the vessel.…”

Assessment of recurrent mesenteric ischemia after stenting with a pressure wire

“…Moneta's criteria, published in 1991, uses a peak systolic velocity (PSV) of >200 cm/sec for a stenosis of >70% of the CA and >275 cm/sec for the SMA. 4 There is even less consensus as to the appropriate duplex criteria to identify restenosis of the CA or SMA after stenting since the criteria of Moneta tends to overestimate the degree of stenosis. 5 Several alternatives in the literature use a PSV of >330 cm/sec or even >400 cm/sec to identify hemodynamically significant instent restenosis of the SMA.…”