mesenteric arteries

Objectives

  • Chronic mesenteric ischemia symptoms

  • ICAVL vessel documentation requirements

  • Collateral pathways to hepatic and splenic arteries during celiac artery occlusion

  • Doppler waveform differences in celiac and superior mesenteric arteries

  • Definition of compensatory flow

  • Indications beyond chronic mesenteric ischemia for mesenteric artery duplex

  • Median arcuate ligament compression syndrome definition

Background

  • Mesenteric duplex exams are accurate for stenosis/occlusion detection

  • Applications: aneurysm/dissection identification, median arcuate ligament syndrome evaluation, and postoperative follow-up

  • Chronic mesenteric ischemia is the primary use of mesenteric duplex

  • Symptoms are nonspecific, often affecting two of three mesenteric vessels before presentation

  • Most common in women aged 40-70

Anatomy of Mesenteric Arteries

  • Celiac Artery: First branch of abdominal aorta, supplies common hepatic, splenic, and left gastric arteries

  • Superior Mesenteric Artery: Located below celiac artery, supplies midgut

  • Inferior Mesenteric Artery: Supplies hindgut, arises above aortic bifurcation

  • Collateral Systems: Include superior mesenteric artery branches and the Arc of Riolan

Patient Preparation

  • Signs/symptoms of chronic mesenteric ischemia: abdominal pain post-meal, abdominal bruit, weight loss

  • Fasting for 6 hours is essential pre-exam

  • Patient should avoid smoking or gum before examination

Required Documentation

  • Doppler waveforms from adjacent aorta, celiac artery, SMA, IMA, and relevant branches

Scanning Technique

  • Begin below xiphoid in transverse view

  • Use sagittal and transverse views for vessel identification

  • Obtain PSV and EDV for all vessels; record poststenotic turbulence in presence of stenosis

Technical Considerations

  • Doppler angles must be 60 degrees or less

  • Adjust configurations based on flow direction and turbulence

  • Evaluate stents using previous imaging for comparison

Diagnosis

  • Celiac Artery: Normal PSV < 125 cm/s; ≥ 200 cm/s indicates ≥70% stenosis

  • Superior Mesenteric Artery: Normal PSV < 125 cm/s; ≥ 275 cm/s indicates ≥70% stenosis

  • Inferior Mesenteric Artery: High resistance, no specific disease criteria

Disorders

  • Median Arcuate Ligament Compression Syndrome: Celiac artery compression during respiration

  • Aneurysms: Primarily in splenic arteries; treatment varies between surgery and endovascular repair

  • Dissections: Caused by various factors; treatment includes monitoring or surgical options

  • Acute Mesenteric Ischemia: Emergency condition; assessment not usually feasible due to symptoms severity