André S van Petersen1, Jeroen J Kolkman2, Robbert Meerwaldt3, Ad B Huisman4, Job van der Palen5, Clark J Zeebregts6, Robert H Geelkerken3. 1. Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands; Division of Vascular Surgery, Department of Surgery, Bernhoven Hospital, Oss-Uden-Veghel, The Netherlands. Electronic address: a.vanpetersen@bernhoven.nl. 2. Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 3. Division of Vascular Surgery, Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands. 4. Division of Interventional Radiology, Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands. 5. Department of Epidemiology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands. 6. Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: The mesenteric circulation has an extensive collateral network. Therefore, stenosis in one or more mesenteric arteries does not necessarily lead to symptoms. The objective of this study was to determine the effect of collateral flow on celiac artery (CA) and superior mesenteric artery (SMA) duplex parameters. METHODS: Between 1999 and 2007, a cohort of 228 patients analyzed for suspected chronic mesenteric syndrome was studied. Stenosis of the mesenteric vessels and collateral flow patterns were identified on angiography and categorized. The effect of stenosis in one mesenteric vessel and the presence of collaterals from the other unaffected vessel was examined in both the CA and SMA. RESULTS: Stenosis of the CA resulted in a significantly higher peak systolic velocity (PSV) and end-diastolic velocity in the normal SMA without stenosis. This was also found for the CA without stenosis in the presence of a stenosis of the SMA. An incremental effect of the severity of the CA stenosis was found with a mean SMA PSV of 158 cm/s when normal and 259 cm/s when occluded. The presence of collaterals had a clear effect on duplex parameters of the angiographically normal SMA. In the presence of collaterals and a 70% CA stenosis, the PSV in the normal SMA was significantly higher (P = .025). CONCLUSIONS: This study shows that stenosis in either the CA or SMA increases flow velocities in the other unaffected mesenteric artery. This increase was correlated with the presence of collaterals. Collaterals and stenoses in one of the mesenteric arteries may lead to mimicking or overgrading of stenosis in the other mesenteric artery.
BACKGROUND: The mesenteric circulation has an extensive collateral network. Therefore, stenosis in one or more mesenteric arteries does not necessarily lead to symptoms. The objective of this study was to determine the effect of collateral flow on celiac artery (CA) and superior mesenteric artery (SMA) duplex parameters. METHODS: Between 1999 and 2007, a cohort of 228 patients analyzed for suspected chronic mesenteric syndrome was studied. Stenosis of the mesenteric vessels and collateral flow patterns were identified on angiography and categorized. The effect of stenosis in one mesenteric vessel and the presence of collaterals from the other unaffected vessel was examined in both the CA and SMA. RESULTS: Stenosis of the CA resulted in a significantly higher peak systolic velocity (PSV) and end-diastolic velocity in the normal SMA without stenosis. This was also found for the CA without stenosis in the presence of a stenosis of the SMA. An incremental effect of the severity of the CA stenosis was found with a mean SMA PSV of 158 cm/s when normal and 259 cm/s when occluded. The presence of collaterals had a clear effect on duplex parameters of the angiographically normal SMA. In the presence of collaterals and a 70% CA stenosis, the PSV in the normal SMA was significantly higher (P = .025). CONCLUSIONS: This study shows that stenosis in either the CA or SMA increases flow velocities in the other unaffected mesenteric artery. This increase was correlated with the presence of collaterals. Collaterals and stenoses in one of the mesenteric arteries may lead to mimicking or overgrading of stenosis in the other mesenteric artery.
Authors: Miklosh Bala; Jeffry Kashuk; Ernest E Moore; Yoram Kluger; Walter Biffl; Carlos Augusto Gomes; Offir Ben-Ishay; Chen Rubinstein; Zsolt J Balogh; Ian Civil; Federico Coccolini; Ari Leppaniemi; Andrew Peitzman; Luca Ansaloni; Michael Sugrue; Massimo Sartelli; Salomone Di Saverio; Gustavo P Fraga; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-07 Impact factor: 5.469
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