title: Mesenteric stenosis, collaterals, and compensatory blood flow.
abstract: BACKGROUND
  The mesenteric circulation has an extensive collateral network. Therefore, stenosis in one or more mesenteric arteries does not necessarily lead to symptoms. The objective of this study was to determine the effect of collateral flow on celiac artery (CA) and superior mesenteric artery (SMA) duplex parameters.
  
  
  METHODS
  Between 1999 and 2007, a cohort of 228 patients analyzed for suspected chronic mesenteric syndrome was studied. Stenosis of the mesenteric vessels and collateral flow patterns were identified on angiography and categorized. The effect of stenosis in one mesenteric vessel and the presence of collaterals from the other unaffected vessel was examined in both the CA and SMA.
  
  
  RESULTS
  Stenosis of the CA resulted in a significantly higher peak systolic velocity (PSV) and end-diastolic velocity in the normal SMA without stenosis. This was also found for the CA without stenosis in the presence of a stenosis of the SMA. An incremental effect of the severity of the CA stenosis was found with a mean SMA PSV of 158 cm/s when normal and 259 cm/s when occluded. The presence of collaterals had a clear effect on duplex parameters of the angiographically normal SMA. In the presence of collaterals and a 70% CA stenosis, the PSV in the normal SMA was significantly higher (P = .025).
  
  
  CONCLUSIONS
  This study shows that stenosis in either the CA or SMA increases flow velocities in the other unaffected mesenteric artery. This increase was correlated with the presence of collaterals. Collaterals and stenoses in one of the mesenteric arteries may lead to mimicking or overgrading of stenosis in the other mesenteric artery.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands; Division of Vascular Surgery, Department of Surgery, Bernhoven Hospital, Oss-Uden-Veghel, The Netherlands. Electronic address: a.vanpetersen@bernhoven.nl.
authors.forename: André S
authors.initials: AS
authors.lastname: van Petersen
authors.affiliation: Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Meerwaldt
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Ad B
authors.initials: AB
authors.lastname: Huisman
authors.affiliation: Department of Epidemiology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003097:Collateral Circulation / Q000502:physiology*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D065666:Mesenteric Ischemia; D008875:Middle Aged; D013152:Splanchnic Circulation / Q000502:physiology*; D018616:Ultrasonography, Doppler, Duplex; D014652:Vascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055815:Young Adult