title: Color duplex ultrasonography of the superior mesenteric artery after placement of endografts with suprarenal stents.
abstract: After endovascular repair of abdominal aortic aneurysm with endografts with suprarenal stents, the proximal uncovered stent may cross the origin of the superior mesenteric artery. Effects on splanchnic circulation are unknown and may include development of stenosis at the vicinity of the stent. The criteria of high-grade superior mesenteric artery stenosis using color duplex ultrasonography have been previously reported. The purpose of this study is to examine the incidence of high-grade superior mesenteric artery stenosis in patients with endografts with suprarenal stents using color duplex ultrasonography. Candidates for the study were patients who had placement of an aortic endograft with a suprarenal stent and were able to undergo ultrasonography of the superior mesenteric artery. After reviewing computed tomography scans, patients who had the origin of the superior mesenteric artery crossed by the suprarenal stent underwent color duplex ultrasonography of this vessel. Presence of turbulence or narrowing of the superior mesenteric artery, or a peak systolic velocity greater than 2.75 m/sec, or an end-diastolic velocity greater than 0.45 m/sec were considered significant for the presence of high-grade superior mesenteric artery stenosis. There were 24 patients (21 males, three females), median age 71 years (range, 59-83). The suprarenal stent was crossing the superior mesenteric artery in 17 of 24 patients (71%). Color duplex ultrasound was technically successful in 13 of 17 (76%). The test was performed after a median follow-up of 9 months (range, 3 days to 34 months). No patient had evidence of turbulence or narrowing of the superior mesenteric artery during ultrasonography. The median peak systolic velocity was 0.92 m/sec (range, 0.53-1.21 m/sec). No patient had peak systolic velocity greater than 2.75 m/sec. The median end-diastolic velocity was 0.10 m/sec (range, 0.09-0.14 m/sec). No patient had end-diastolic velocity greater than 0.45 m/sec. Color duplex ultrasonography did not demonstrate the presence of high-grade superior mesenteric artery stenosis during early follow-up of patients with endografts with suprarenal stents. Longer follow-up of larger series of patients is needed to determine the long-term effects of suprarenal stents on splanchnic circulation.
authors.affiliation: Division of Vascular Surgery, Nottingham University Hospital, Nottingham, United Kingdom. kalliafa@otenet.gr
authors.forename: Stavros
authors.initials: S
authors.lastname: Kalliafas
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Travis
authors.forename: Jan
authors.initials: J
authors.lastname: Macierewicz
authors.forename: Syed W
authors.initials: SW
authors.lastname: Yusuf
authors.forename: Simon C
authors.initials: SC
authors.lastname: Whitaker
authors.forename: Ian
authors.initials: I
authors.lastname: Davidson
authors.forename: Brian R
authors.initials: BR
authors.lastname: Hopkinson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D013152:Splanchnic Circulation / Q000502:physiology; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color