title: Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease.
abstract: Duplex ultrasound criteria for the diagnosis of celiac and superior mesenteric artery (SMA) occlusive disease have not been well defined. We performed a blinded retrospective comparison of mesenteric duplex data with arteriography in 24 consecutive patients who underwent both studies. Arteriography revealed that eight superior mesenteric arteries were normal; five were minimally stenotic; eight had stenoses greater than or equal to 50%, and three were occluded. Nine celiac arteries were normal or minimally stenotic; 12 had stenoses greater than or equal to 50%, and three were occluded. Duplex scans were obtained after an overnight fast. In normal superior mesenteric arteries, peak systolic velocity (PSV) was 134 +/- 18 cm/sec and end-diastolic velocity (EDV) was 24 +/- 4 cm/sec. Superior mesenteric artery PSV in patients with minimal or no stenosis (171 +/- 22 cm/sec) was less than PSV in patients with severe (greater than 50%) stenosis (299 +/- 40 cm/sec, p = 0.006), and less than PSV in patients with patent superior mesenteric arteries who underwent revascularization (366 +/- 86 cm/sec, p = 0.017). Similarly, EDV was elevated in superior mesenteric arteries with severe stenosis (78 +/- 11 cm/sec, p = 0.001) and in patients who underwent revascularization (111 +/- 19 cm/sec, p less than 0.001) compared to those with less than 50% stenosis (30 +/- 6 cm/sec, p = 0.001). An EDV greater than 45 cm/sec was the best indicator of severe stenosis (sensitivity, 1.0; specificity, 0.92). Peak systolic velocity greater than 300 cm/sec was less sensitive (0.63), but highly specific (1.0) for severe superior mesenteric artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH.
authors.forename: J C
authors.initials: JC
authors.lastname: Bowersox
authors.forename: R M
authors.initials: RM
authors.lastname: Zwolak
authors.forename: D B
authors.initials: DB
authors.lastname: Walsh
authors.forename: J R
authors.initials: JR
authors.lastname: Schneider
authors.forename: A
authors.initials: A
authors.lastname: Musson
authors.forename: F E
authors.initials: FE
authors.lastname: LaBombard
authors.forename: J L
authors.initials: JL
authors.lastname: Cronenwett
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity; D002445:Celiac Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods