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 ≥50%, and three were occluded. Nine celiac arteries were normal or minimally stenotic; 12 had stenoses ≥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 (>50%) stenosis (299 ± 40 cm/sec, p = 0.006), and less than PSV in patients with patent superior mesenteric arteries who underwent revascularization (336 ± 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 p = 0.001). An EDV >45 cm/sec was the best indicator of severe stenosis (sensitivity, 1.0; specificity, 0.92). Peak systolic velocity >300 cm/sec was less sensitive (0.63), but highly specific (1.0) for severe superior mesenteric artery stenosis. Triphasic superior mesenteric artery Doppler waveforms were present only in normal or minimally stenotic superior mesenteric arteries, making their absence sensitive (1.0), but not specific (0.46) for severe superior mesenteric artery stenosis. Normal superior mesenteric arteries had biphasic low resistance waveforms in the presence of replaced right hepatic arteries. Monophasic superior mesenteric arteries were found occasionally in less stenotic arteries in the presence of severe celiac stenosis or occlusion. Celiac arteries that were normal or minimally stenotic had low resistance biphasic waveforms with PSV=152 ± 40 and EDV=40 + 7, whereas stenotic celiacs had monophasic signals, variable velocities, and were often difficult to insonate adequately. Overall, eight patients underwent mesenteric revascularization, and each had an abnormal outcome on preoperative duplex examination. We conclude that mesenteric duplex ultrasonography is an effective diagnostic tool and should be considered early in the evaluation of patients with suspected chronic mesenteric artery occlusive disease. (J VASC SURG 1991;14:780-8.)