Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries
Open accessAbstract
Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. Methods A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination <4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR. Results There were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with <70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with <70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%. Conclusions Increasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.
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The presence of a stent in the CA or SMA can generate artefacts and hinder quantification of the stenosis.
“The presence of a stent in the CA or SMA can generate artefacts and hinders quantification of the stenosis, and additional CTA may be required. 27,28”
PSV thresholds for (clinically) significant ISR in the CA ranged between 289 cm/s and 440 cm/s.
“PSV thresholds for (clinically) significant ISR in the CA ranged between 289 cm/s 27 and 440 cm/s.”
Various small studies have assessed DUS for the detection of ≥70% SMA in stent re-stenosis (ISR) and found optimal PSV cutoff values between 300 cm/s and 400 cm/s.
“Various small studies have assessed DUS for the detection of 70% SMA in stent re-stenosis (ISR) and found optimal PSV cutoff values between 300cm/s and 400 cm/s.”
Several studies have shown that the PSV is higher in stented than in native mesenteric arteries.
“Several studies have shown that the PSV is higher in stented than in native mesenteric arteries.”
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- Authors
- Soult, M. C., Wuamett, J. C., Ahanchi, S. S., Stout, C. L., Larion, S., & Panneton, J. M.
- Affiliations
- Eastern Virginia Medical School (US)
- Corresponding author
- Panneton, Jean M.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2016-11
- Volume
- 64
- Issue
- 5
- Pages
- 1366-1372
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2520345481
- Cited by
- 28
- References
- 21
- Citations by year
- 2026: 3 · 2025: 4 · 2023: 3 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 2 · 2018: 3 · 2017: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Keywords
- in-stent restenosis, superior mesenteric artery, celiac artery, duplex ultrasound, peak systolic velocity, stent patency, visceral artery stenting, high-grade stenosis
- MeSH terms
- Aged, Aged, 80 and over, Angiography, Blood Flow Velocity, Celiac Artery, Constriction, Pathologic, Female, Humans, Male, Mesenteric Vascular Occlusion, Middle Aged, Predictive Value of Tests, Recurrence, Retrospective Studies, ROC Curve, Splanchnic Circulation, Time Factors, Vascular Patency, Virginia, Reproducibility of Results, Stents, Mesenteric Artery, Superior, Ultrasonography, Doppler, Duplex, Area Under Curve, Endovascular Procedures
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