Visceral Duplex Scanning: Evaluation Before and After Artery Intervention for Chronic Mesenteric Ischemia

Abstract

Color duplex ultrasound testing has evolved to be a clinically useful modality to diagnose chronic mesenteric ischemia caused by visceral artery origin atherosclerosis. Testing requires expertise in ultrasound imaging, visceral artery hemodynamics, and duplex scan interpretation. Patient can be accurately screened for severe stenosis or occlusion involving celiac, superior mesenteric, or inferior mesenteric arteries. Duplex testing can also evaluate functional patency following visceral bypass grafting procedures or endovascular stent-angioplasty. The focus of duplex surveillance after visceral artery intervention is to identify severe repair site stenosis, which can develop with symptoms of gut ischemia. Visceral duplex testing of a bypass graft or stent-angioplasty site that shows peak systolic velocities >300 cm/s with end-diastolic velocities >50 to 70 cm/s, or a decreased graft velocity peak systolic velocity <40 cm/s should be considered for interrogation using angiography to confirm or exclude severe (>70%) stenosis. Duplex testing after surgical or endovascular visceral interventions is a screening study, which compliments clinical follow-up by aiding the vascular surgeon in timely identification of visceral repairs that have developed a progressive, high-grade stenosis.