Mesenteric Doppler

Patient Prep for Mesenteric Study

NPO ≥ 6 hours - schedule early to avoid bowel gas

No smoking or gum chewing

Medications with water only

Patient supine

Low frequency curved transducer

Protocol for Mesenteric Study

RUQ first - eliminate GB as pain source

Pre and post-prandial images - 2D, color, spectral

Aorta at level of celiac axis and SMA

Origin of celiac axis

Origin of SMA

Origin of IMA

Celiac Artery

Celiac Artery Doppler Waveform

Low resistant

Celiac Artery PSV

101 cm/sec

Celiac Artery RI

0.7

70% Celiac Artery Stenosis PSV

≥ 200 cm/sec

Celiac Artery Occlusion

Results in SMA collaterals diverting blood through gastroduodenal artery toward the liver and spleen

Celiac Artery Aneurysm

Splenic Artery Aneurysm

Seen in women

Replaced Right Hepatic Artery

Right hepatic artery branches off something else besides celiac artery - usually SMA

Hepatic Artery Retrograde Flow

Due to celiac artery occlusion

Blood flows towards splenic artery - RABT color pattern

SMA

Pre-Prandial SMA Doppler

Post-Prandial SMA Doppler

SMA PSV

113 cm/sec

SMA Stenosis

High velocity jet

Distal tardus parvus flow

70% SMA Stenosis PSV

≥ 275 cm/sec

SMA Aneurysm

SMA Dissection

Common Trunk Variant

Celiac and SMA come off common trunk

IMA

IMA PSV

141 cm/sec

IMA Stenosis PSV

> 200 cm/sec

Prominent IMA

Due to SMA occlusion

IMA Aneurysm

Acute Mesenteric Ischemia

Thrombosis of one or more mesenteric vessels

Life threatening - requires immediate intervention

Severe cramping/pain - disproportional pain

Chronic Mesenteric Ischemia

Low resistant pre-prandial doppler signals

70% occlusion of 2/3 splanchnic arteries required for diagnosis (celiac, SMA, IMA)

Epigastric pain after eating - fear of food, weight loss, decreased nutrition

Compensatory Flow

Elevated velocities in normal collateral vessels

No stenotic profile seen

Aneurysm

Most common in splenic artery

Life threatening if ruptured

Dissection

Separation of channels - flap line

To and fro flow

Bypass Graft Protocol

Inflow artery

Proximal anastomosis

Length of graft

Distal anastomosis

Outflow artery

Median Arcuate Ligament Syndrome (MALS)

Compression of celiac axis during exhalation by median arcuate ligament

Pain relieved by inhalation

Evaluate in supine & upright positions and with inspiration & expiration

Celiac Artery PSV with MALS

> 250 cm/sec during expiration that normalizes with inspiration