Vascular Health and Risk Management (Apr 2022)

Early Identification of Chronic Mesenteric Ischemia with Endoscopic Duplex Ultrasound

  • Safi N,
  • Ånonsen KV,
  • Berge ST,
  • Medhus AW,
  • Sundhagen JO,
  • Hisdal J,
  • Kazmi SSH

Journal volume & issue
Vol. Volume 18
pp. 233 – 243

Abstract

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Nathkai Safi,1,2 Kim Vidar Ånonsen,3 Simen Tveten Berge,1,2 Asle Wilhelm Medhus,3 Jon Otto Sundhagen,1 Jonny Hisdal,1,2 Syed Sajid Hussain Kazmi1,2 1Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, Oslo, Norway; 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; 3Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, NorwayCorrespondence: Syed Sajid Hussain Kazmi, Tel +47 92468309, Email [email protected]: 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.Keywords: chronic mesenteric ischemia, intestinal ischemia, acute mesenteric ischemia, duplex ultrasound, computed tomography angiography, MALS

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