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Home > Vascular Annual Meeting > RR27. Visceral Artery Duplex Ultrasound Velocity...

RR27. Visceral Artery Duplex Ultrasound Velocity Criteria for Instent Stenosis Following Mesenteric Artery Stenting: Validated with Arteriography

Christopher L. Stout1, Cory A. Messerschmidt2, Greg C. Schmieder1, Albert I. Richardson, II1, Gordon K. Stokes1, Jean M. Panneton1
1Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA; 2Eastern Virginia Medical School, Norfolk, VA

OBJECTIVES: The number of patients undergoing endovascular therapy for mesenteric ischemia is rapidly increasing. The accuracy of mesenteric duplex ultrasound (DUS) has not been established for the prediction of in-stent restenosis (ISR) of the celiac (CA) or superior mesenteric artery (SMA). The purpose of this study is to determine DUS velocity criteria for mesenteric stents.

METHODS: A retrospective review all consecutive patients that underwent endovascular stenting from July 2004 to July 2008 was completed. The angiography (DSA) and DUS were performed within three months of each other to be considered paired measurements. Standard statistical analysis was performed.

RESULTS: There were 53 SMA and 17 CA ultrasound and angiography pairs. CA analysis of receiver operator curves (ROC) showed no discrimination between DUS and greater than 70% stenosis on DSA, p=0.65. Using all CA paired studies, a velocity of 226 cm/s has a sensitivity of 1 and specificity of 0.33 and a velocity of 449 cm/s has a sensitivity of 0.50 and specificity of 0.87 (Table 1). SMA analysis of ROC curves showed an AUC of 0.74 between DUS and greater than 70% stenosis on DSA, p=0.007. Using all paired SMA studies, a velocity of 302 cm/s has a sensitivity of 1 and specificity of 0.5 and a velocity of 645 cm/s has a sensitivity of 0.27 and specificity of 1 (Table 1).

CONCLUSIONS: Duplex ultrasound grading of stent restenosis for mesenteric vessels has not been validated. Superior mesenteric artery stent stenosis can be diagnosed with good sensitivity and PPV using DUS. This data can help guide the decision to perform arteriography for specific DUS velocities of mesenteric stents.

AUTHOR DISCLOSURES: C.L. Stout, None; C.A. Messerschmidt, None; G.C. Schmieder, None; A.I. Richardson, None; G.K. Stokes, None; J.M. Panneton, None.

Table 1.

Table 2.