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Cited by 14Abdominal vascular conditions and treatmentsAppendicitis Diagnosis and ManagementGastrointestinal Bleeding Diagnosis and Treatment

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Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study

Sartini, Stefano, Calosi, Guido, Granai, Carolina, Harris, Tim, Bruni, Fulvio, Pastorelli, Marcello·2017·European Journal of Emergency Medicine
DOI 10.1097/mej.0000000000000378
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Abstract

Objective: Acute mesenteric ischemia (AMI) is a life-threatening condition requiring time-dependent treatment; thus, early recognition may improve outcomes. We hypothesized that clinician-performed mesenteric vessels duplex ultrasound (DUS) could facilitate early identification of patients with AMI in high-risk patients presenting with abdominal pain. Methods: This was a single-operator, observational, prospective cohort study. Patients aged at least 65 presenting to Emergency Departments with acute abdominal pain and no clear diagnosis after an initial work-up were enrolled. All patients underwent multidetector computed tomography and these findings provided the reference standard in this study. DUS of the celiac artery and superior mesenteric artery (SMA) were obtained to measure the peak systolic velocity (PSV) and were performed within 24 h of admission. PSVs outside the normal range were considered to indicate AMI. Results: Of 49 patients identified, 47 were consented to enrollment and diagnostic images were obtained in 45 (96%). Fifteen patients (33%) had AMI (six occlusive, nine nonocclusive disease). Among these, 12 (80%) had abnormal DUS velocities. SMA PSV showed a sensitivity of 78.57% [95% confidence interval (CI): 49.2–95.34], a specificity of 64.52% (95% CI: 45.37–80.77), a positive predictive value of 50% (95% CI: 28.22–71.78), and a negative predictive value of 86.96% (95% CI: 66.41–97.22) for AMI. DUS had a sensitivity of 100%, a specificity of 64%, and a negative predictive value of 100% for occlusive AMI. Assessment of celiac artery PSV did not improve diagnostic performance. Conclusion: In this single-operator pilot study, mesenteric vessel DUS was performed successfully in the Emergency Department, with a high proportion of diagnostic images obtained. A normal SMA PSV was associated with a low risk of occlusive AMI.

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Research works printed but not linked: 34

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Metadata

Authors
Sartini, S., Calosi, G., Granai, C., Harris, T., Bruni, F., & Pastorelli, M.
Affiliations
  • Whipps Cross University Hospital (GB)
  • Emergency Medicine Department
  • Azienda Ospedaliera Universitaria Senese (IT)
  • Queen Mary University of London (GB)
Corresponding author
Sartini, Stefano
ORCID
Sartini, Stefano
Venue
European Journal of Emergency Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-12
Volume
24
Issue
6
Pages
e21-e26
ISSN
0969-9546 (ISSN-L)
DOI
10.1097/mej.0000000000000378
OpenAlex
W2331646207
Cited by
14
References
9
Citations by year
2026: 1 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 1 · 2017: 2
FWCI
0.74
Type
journal article
Language
en
Open access
closed
Locations
  • European Journal of Emergency Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords
acute mesenteric ischemia, duplex ultrasound, superior mesenteric artery, celiac artery, peak systolic velocity, early diagnosis, acute abdominal pain, nonocclusive mesenteric ischemia, emergency department, diagnostic accuracy
MeSH terms
Computed Tomography Angiography, Acute Disease, Adult, Aged, Celiac Artery, Emergency Service, Hospital, Female, Humans, Italy, Longitudinal Studies, Male, Middle Aged, Pilot Projects, Predictive Value of Tests, Prospective Studies, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Cohort Studies, Mesenteric Artery, Superior, Ultrasonography, Doppler, Duplex, Early Diagnosis, Multidetector Computed Tomography, Mesenteric Ischemia

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