Noninvasive Diagnosis of Intestinal Angina

Abstract

Intestinal angina occurs when the visceral arteries are unable to provide sufficient blood flow to meet the increased metabolic demands of the postprandial state. For this to occur, it is generally necessary for there to be hemodynamically significant stenoses or occlusions of a t least two of the three major arteries which supply the gastrointestinal tract. Because this syndrome has no associated pathognomonic symptoms and signs, it can only be implicated by exclusion.' -Confirmation of the diagnosis requires contrast angiography. There is a need for a highly sensitive and specific noninvasive test for mesenteric arterial insufficiency.Ultrasonic duplex scanning provides anatomic information relating to arterial luminal narrowing and is also capable of providing quantitative information about blood flow velocity. The test has been highly successful in the noninvasive diagnosis of extracranial cerebrovascular disease,4 and in the localization of peripheral arterial s t e n~s i s .~ This report documents the use of this technique for the diagnosis of intestinal angina. CASE REPORTA 54-year-old female presented with a 6-month history of postprandial epigastric pain and diarrhea. These symptoms caused involuntary curtailment of the size and frequency of meals, with a reported 30-pound weight loss. The patient had been taking conjugated estrogens for the treatment of menopausal symptoms. She noted that discontinuation of the drug slightly alleviated these symptoms. The postprandial pain was also relieved by sublingual nitroglycerin tablets, but

Duplex criteria for native superior mesenteric artery stenosis overestimate stenosis in stented superior mesenteric arteries

“…1,2 There are now well established duplex ultrasound scan criteria for identification of high-grade stenosis in the superior mesenteric artery (SMA). Studies performed at our institution comparing mesenteric duplex scans and arteriograms demonstrated that an SMA peak systolic velocity (PSV) of Ն 275 cm/second or no flow signal is a reliable indicator of a 70% or greater angiographic stenosis of the SMA.…”

Intestinal phase of superior mesenteric artery blood flow in man.

“…The introduction of the ultrasonic pulsed Doppler technique (duplex scanning) for mesenteric blood flow measurements has made it possible to study the relation between intestinal function and intestinal blood flow in health and disease.? 5 The method is non-invasive, and gives consistent and reproducible results after physiological stimuli such as food intake. 67 The intake of food results in an increase in superior mesenteric artery blood flow (SMABF) in man after liquid meals."'…”

Doppler ultrasound in the diagnosis of intestinal ischemia

“…As far as we know this has only been reported on one previous occasion [7]. Since the celiac and carotid arteries are of a similar diameter it is not surprising that stenoses of these arteries can produce similar Doppler spectrum abnormalities.…”