Clinical usefulness with the combination of color Doppler and contrast-enhanced harmonic EUS for the assessment of visceral vascular diseases.
OBJECTIVE
To evaluate the clinical usefulness of the color Doppler and contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in diagnosing visceral vascular diseases and in assessing morphologic and hemodynamic characteristics required for optimized patient management.


BACKGROUND
Mesenteric arteries are easily accessible with EUS because of its proximities to the gastrointestinal tract.


METHODS
EUS was performed in 12 patients with clinically suspected visceral vascular disease, as determined by computed tomography (CT) scan between February 2012 and March 2013. Conventional B-mode, color Doppler, and CEH-EUS was performed to evaluate vascular status of the celiac artery and superior mesenteric artery (SMA).


RESULTS
CT scan imaging suggested arterial dissection in 9 patients; arterial stenosis or occlusion in 2 patients, and periarterial soft tissue cuffing in 1 patient. EUS accurately identified all the visceral vascular lesions of 11 patients and 1 patient with suspected SMA dissection on CT imaging was proven to be normal by EUS. EUS also identified one undefined dissection not detected on abdominal CT. EUS examination revealed vascular intimal flap in 5 patients and blood flow within the true lumen and thrombi within the false lumen in 8 patients. In addition, the stenotic area could be calculated using color Doppler EUS. Two patients underwent surgical thrombectomy and angioplasty because of total occlusion of SMA on color Doppler and CEH-EUS.


CONCLUSIONS
The combination of color Doppler and CEH-EUS may be a promising diagnostic modality to assess the splanchnic artery without exposure to radiation. Moreover, EUS is a useful tool to determine the appropriate treatment options for patients with isolated mesenteric artery dissection.
*Department of Internal Medicine, Division of Gastroenterology †Department of Surgery, Division of Vascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Woo Hyun
WH
Paik
Jun-Ho
JH
Choi
Dong Wan
DW
Seo
Yong-Pil
YP
Cho
Do Hyun
DH
Park
Sang Soo
SS
Lee
Sung Koo
SK
Lee
Myung-Hwan
MH
Kim
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000628:therapy; D017130:Angioplasty; D002445:Celiac Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003251:Constriction, Pathologic; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy; D008875:Middle Aged; D010743:Phospholipids; D011237:Predictive Value of Tests; D013459:Sulfur Hexafluoride; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride