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Cited by 7Abdominal vascular conditions and treatmentsVascular anomalies and interventionsRenal and Vascular Pathologies

Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound

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Safi, Nathkai, Ånonsen, Kim Vidar, Berge, Simen Tvetan, Medhus, Asle Wilhelm, Sundhagen, Jon Otto, Hisdal, Jonny, Kazmi, Syed Sajid Hussain·2022·Vascular Health and Risk Management
DOI 10.2147/vhrm.s358570PMC PMC9005355
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Abstract

Introduction: Due to diagnostic delay, chronic mesenteric ischemia (CMI) is underdiagnosed. We assumed that the patients suspected of CMI of the atherosclerotic origin or median arcuate ligament syndrome (MALS) could be identified earlier with endoscopic duplex ultrasound (E-DUS). Patients and Methods: Fifty CMI patients with CTA-verified stenosis of either ≥50% and ≥70% of celiac artery (CA) and superior mesenteric artery (SMA) were examined with E-DUS and transabdominal duplex ultrasound (TA-DUS). Peak systolic velocities (PSV) of ≥200cm/s and ≥275cm/s for CA and SMA, respectively, were compared with CTA. Subgroup analysis was performed for the patients with (n=21) and without (n=29) prior revascularization treatment of CMI. The diagnostic ability of E-DUS and TA-DUS was tested with crosstabulation analysis. Receiver operating characteristics (ROC) curve analysis was performed, and the area under the curve (AUC) was calculated to investigate the test accuracy. Results: In the patients with ≥70% stenosis, E-DUS had higher sensitivity than TA-DUS (91% vs 81% for CA and 100% vs 92% for SMA). AUC for SMA ≥70% in E-DUS was 0.75 and with TA-DUS 0.68. The sensitivity of E-DUS for CTA-verified stenosis ≥70% for CA was 100% in the patients without prior treatment. E-DUS demonstrated higher sensitivity than TA-DUS for both arteries with stenosis ≥50% and ≥70% in the treatment-naive patients. Conclusion: E-DUS is equally valid as TA-DUS for the investigation of CMI patients and should be used as an initial diagnostic tool for patients suspected of CMI.

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  • Endoscopic duplex ultrasound is not often used clinically and is not considered standard of care.

    “Endoscopic duplex ultrasound has been found to have an even higher sensitivity than transabdominal duplex ultrasound but is not often used clinically and is not considered standard of care [66].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [66]

    The Background (page unavailable) says guidelines recommend transabdominal duplex ultrasound, rather than E-DUS, for initial investigation and follow-up; the Conclusion proposes E-DUS as an initial diagnostic tool. This supports the distinction from guideline-recommended care, but the paper does not say how often E-DUS is used clinically. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Endoscopic duplex ultrasound has higher sensitivity than transabdominal duplex ultrasound for chronic mesenteric ischemia.

    “Endoscopic duplex ultrasound has been found to have an even higher sensitivity than transabdominal duplex ultrasound but is not often used clinically and is not considered standard of care [66].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [66]

  • In a validation study of 50 patients, the sensitivity of EDUS to detect a >70% stenosis was 91% for the CA and 100% for the SMA, and for transabdominal DUS it was 81% for the CA and 92% for the SMA.

    “In a validation study of 50 patients with CTA as reference standard, the sensitivity of EDUS to detect a > 70% stenosis was 91% for the CA and 100% for the SMA, and for transabdominal DUS it was 81% for the CA and 92% for the SMA. 29”

    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 [29]

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  1. [26]Hosmer DW, Lemeshow S. Area under the ROC curve. Appl Logist Regres. 2000;160:164.

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Authors
Safi, N., Ånonsen, K. V., Berge, S. T., Medhus, A. W., Sundhagen, J. O., Hisdal, J., & Kazmi, S. S. H.
Affiliations
Oslo University Hospital (NO)
Corresponding author
Kazmi, Syed Sajid Hussain
ORCID
Venue
Vascular Health and Risk Management
Publisher
Informa UK Limited
Published
2022-04
Volume
Volume 18
Pages
233-243
ISSN
  • 1176-6344 (ISSN-L)
  • 1178-2048
DOI
10.2147/vhrm.s358570
PMC
PMC9005355
OpenAlex
W4226154052
Cited by
7
References
28
Citations by year
2025: 3 · 2024: 2 · 2023: 1 · 2022: 1
FWCI
1.67
Type
journal article
Language
en
Open access
Licence
Locations
  • Vascular Health and Risk Management (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
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
chronic mesenteric ischemia, celiac artery stenosis, superior mesenteric artery stenosis, median arcuate ligament syndrome, atherosclerosis, peak systolic velocity, diagnostic accuracy, early diagnosis, revascularization
MeSH terms
Blood Flow Velocity, Constriction, Pathologic, Humans, Ischemia, Retrospective Studies, Delayed Diagnosis, Mesenteric Ischemia

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