Interpretation of visceral duplex scanning: before and after intervention for chronic mesenteric ischemia

Abstract

Duplex ultrasound testing has evolved to be a clinically useful modality for the evaluation of chronic mesenteric ischemia (CMI) due to visceral artery origin atherosclerosis. Patients with known or suspected CMI can be scanned to identify stenosis or occlusion of the celiac, superior mesenteric, and inferior mesenteric arteries. Testing requires expertise in abdominal ultrasound imaging and arterial duplex scan interpretation, as well as a fundamental understanding of visceral artery hemodynamics and collateral pathways created as a result of occlusive lesions. Duplex testing can also be utilized to evaluate functional patency after visceral artery bypass grafting procedures or endovascular stent angioplasty, Repair site stenosis can be reliably identified, which assists in decision making regarding the need for re-intervention to treat or prevent recurrent gut ischemia. Visceral duplex testing of a bypass graft or stent angioplasty site that shows peak systolic velocity >300 cm/s with end-diastolic velocities >50-70 cm/s, or a damped velocity spectra within a bypass graft and low (<40 cm/s) peak systolic velocity should be considered for interrogation by visceral angiography to confirm or exclude severe (>70%) stenosis. Visceral duplex testing should be considered a screening diagnostic modality that complements clinical assessment of CMI both before and after open surgical or endovascular visceral artery interventions.