Color Duplex Scanning of Superior Mesenteric and Celiac Artery Stenting

Abstract

Few studies analyzed duplex velocity criteria to identify in-stent celiac artery (CA) and superior mesenteric artery (SMA) stenosis. We conducted a study to analyze duplex velocity criteria in detecting CA and SMA in-stent stenosis. Forty-three patients (with 62 stents 32 SMAs and 30 CAs), who had concurrent postoperative duplex ultrasound scan and angiograms for significant in-stent stenosis by duplex velocity criteria, were analyzed. The mean stented celiac PSV (cm/s) and EDV for >0% in-stent stenosis were 447 and 136 versus 379 and 104 for >0% native stenosis (p 1/4 0.067 and 0.106). The mean stented SMA PSVand EDV for >0% in-stent stenosis were 410 and 114 versus 405 and 76 for >0% native stenosis (p1/4 0.885, 0.037). The PSV cut point for detecting>0%SMAin-stent stenosis was 325 cm/s (sensitivity 89%, specificity 100%, and overall accuracy 91%) versus 295 cm/s for >0% native SMA and for >70%SMA in-stent stenosis was 412 (sensitivity 100%, specificity 95%, and overall accuracy 97%) versus 400 for native stenosis. The PSV cut points for >0% CA in-stent stenosis was 274 cm/s (sensitivity 96%, specificity 86%, and overall accuracy 93%) versus 240 cm/s for >0% native stenosis and for >70% CA in-stent stenosis was 363 (sensitivity 88%, specificity 92%, and overall accuracy 90%) versus 320 cm/s for native stenosis (sensitivity 80%, specificity 89%, and overall accuracy 85%). Receiver operator curve analysis also showed that both PSVs and EDVs were equal predictors for SMA and CA >0% and >70% in-stent stenosis. We concluded that there is a tendency toward higher velocities in stented CA/SMAs in comparison to native arteries. Caution must be exercised in using duplex velocity cutoffs for native CA/SMA stenosis for stented CA/SMA. Further prospective validation studies are needed.