Mesenteric stenosis, collaterals, and compensatory blood flow
Open accessAbstract
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.
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CMI occurs as a result of gradual decrease in blood flow to the intestine; as a result, numerous collaterals develop in the mesenteric circulation.
“CMI occurs as a result of gradual decrease in blood flow to the intestine. As a result, numerous collaterals develop in the mesenteric circulation[33].”
From Ischemic bowel disease in 2021. (2021) · cites this paper as [33]
The Discussion (page unavailable) reports increased collateral development in patients with more than 70% mesenteric arterial stenosis, supporting an association between reduced arterial flow and collaterals. It does not establish that chronic mesenteric ischemia itself causes collaterals to develop; the authors say whether collaterals indicate ischemia still needs confirmation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPSV and EDV in the CA and SMA are significantly higher during expiration than during inspiration.
“since the PSV and EDV in the CA and SMA are significantly higher during expiration than during inspiration. 23,24”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [24]
Supplementary Table IV (Additional information; page not provided) shows higher mean SMA PSV and EDV during expiration than inspiration. The paper also gives higher expiratory than inspiratory PSV cutoffs for both arteries (Duplex ultrasound; page not provided). It does not establish that the respiratory-phase differences are statistically significant for both measures in both arteries; the table’s P values compare collateral groups, not respiratory phases. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe diagnostic accuracy of DUS expressed as area under the ROC curve was similar for examinations during inspiration and expiration.
“However, the diagnostic accuracy of DUS expressed as area under the receiver operating characteristic (ROC) curve was similar for examinations during inspiration and expiration. 24”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [24]
The Duplex ultrasound section describes measurements during inspiration and expiration, and the Abdominal angiography section says scans were compared in the same respiratory phase. Neither reports ROC areas or compares diagnostic accuracy between phases; searches for ROC, AUC, and diagnostic accuracy found no such result in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- van Petersen, A. S., Kolkman, J. J., Meerwaldt, R., Huisman, A. B., van der Palen, J., Zeebregts, C. J., & Geelkerken, R. H.
- Affiliations
- University Medical Center Groningen (NL)
- Medisch Spectrum Twente (NL)
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 60
- Issue
- 1
- Pages
- 111-119.e2
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2130472964
- Cited by
- 87
- References
- 36
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 8 · 2023: 10 · 2022: 5 · 2021: 11 · 2020: 9 · 2019: 6 · 2018: 6 · 2017: 9 · 2016: 9 · 2015: 1
- FWCI
- 6.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Twente Research Information (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Vascular anomalies and interventions
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Keywords
- collateral circulation, chronic mesenteric ischemia, celiac artery stenosis, superior mesenteric artery stenosis, peak systolic velocity, duplex ultrasound, mesenteric artery occlusion, stenosis severity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Aorta, Abdominal, Blood Flow Velocity, Celiac Artery, Collateral Circulation, Constriction, Pathologic, Humans, Ischemia, Middle Aged, Splanchnic Circulation, Vascular Diseases, Angiography, Digital Subtraction, Mesenteric Artery, Superior, Ultrasonography, Doppler, Duplex, Young Adult, Mesenteric Ischemia
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