Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound

Abstract

Introduction Due to diagnostic delay, chronic mesenteric ischemia (CMI) is underdiagnosed. We assumed that the patients suspected of CMI of the atherosclerotic origin or median arcuate ligament syndrome (MALS) could be identified earlier with endoscopic duplex ultrasound (E-DUS). Patients and Methods Fifty CMI patients with CTA-verified stenosis of either ≥50% and ≥70% of celiac artery (CA) and superior mesenteric artery (SMA) were examined with E-DUS and transabdominal duplex ultrasound (TA-DUS). Peak systolic velocities (PSV) of ≥200cm/s and ≥275cm/s for CA and SMA, respectively, were compared with CTA. Subgroup analysis was performed for the patients with (n=21) and without (n=29) prior revascularization treatment of CMI. The diagnostic ability of E-DUS and TA-DUS was tested with crosstabulation analysis. Receiver operating characteristics (ROC) curve analysis was performed, and the area under the curve (AUC) was calculated to investigate the test accuracy. Results In the patients with ≥70% stenosis, E-DUS had higher sensitivity than TA-DUS (91% vs 81% for CA and 100% vs 92% for SMA). AUC for SMA ≥70% in E-DUS was 0.75 and with TA-DUS 0.68. The sensitivity of E-DUS for CTA-verified stenosis ≥70% for CA was 100% in the patients without prior treatment. E-DUS demonstrated higher sensitivity than TA-DUS for both arteries with stenosis ≥50% and ≥70% in the treatment-naive patients. Conclusion E-DUS is equally valid as TA-DUS for the investigation of CMI patients and should be used as an initial diagnostic tool for patients suspected of CMI.

Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

“…The sensitivity of duplex ultrasonography in chronic mesenteric ischemia is 72–100% with a 77–90% specificity [ 77 ]. Endoscopic duplex ultrasound has been found to have an even higher sensitivity than transabdominal duplex ultrasound but is not often used clinically and is not considered standard of care [ 66 ].…”

Endovascular treatment of chronic mesenteric ischaemia secondary to a superior mesenteric artery pseudoaneurysm: a modified neurointerventional technique

“…Chronic mesenteric ischaemia, or ‘abdominal angina’ as it was initially termed, is rare and can be difficult to diagnose due to intermittent symptoms and gradual onset 6 8. Appropriate imaging studies such as abdominal duplex ultrasound, CTA and/or magnetic resonance angiography play an integral role in the correct diagnosis and proper treatment of chronic mesenteric ischaemia 5…”

“…It was hypothesised that since PSAs are susceptible to thrombus formation, if the mid-SMA PSA had allowed for thrombus formation, intermittent microemboli to distal SMA branches could result in a symptomatic postprandial state. This would then lead to chronic mesenteric ischaemia, a rare life-threatening disease that could explain his postprandial abdominal pain, nausea, vomiting and 40-pound unintentional weight loss over the course of a year 4 5…”

Plasma α-Glutathione S-Transferase in Patients with Chronic Mesenteric Ischemia and Median Arcuate Ligament Syndrome

“…A peak systolic velocity (PSV) of ≥200 cm/s in the celiac artery or ≥275 cm/s in the superior mesenteric artery was considered clinically significant. 26 , 27 DUS was repeated at follow-up at 3, 6, 12 months, and yearly after that.…”