Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound.

PURPOSE: To assess the predictive value of ultrasound duplex scanning in the detection of superior mesenteric artery (SMA) and celiac artery (CA) occlusive disease.
METHODS: Thirty-nine patients in whom mesenteric ischemia was suspected were examined with duplex scan and arteriography.
RESULTS: Duplex scan visualized both vessels in all examined patients. An absent Doppler signal from an adequately visualized SMA or CA was a pathognomonic sign for total occlusion of the arteries. Elevated diastolic velocities (peak diastolic velocity > 70 cm/sec for SMA and > 100 cm/sec for CA) were accurate predictors of arteriographically confirmed stenoses > or = 50%. Increased blood velocity was occasionally observed in a thyrotoxic patient with malabsorption-induced weight loss and abdominal pain but arteriographically-normal SMA. Further examinations of hyperthyroid patients showed systematic elevation of peak systolic velocity in the SMA greater than 300 cm/sec but normal diastolic velocities and resistivity indexes.
CONCLUSION: Duplex ultrasound is a highly selective and specific method for detection of SMA and CA occlusive disease. The most accurate predictors of the disease were increased diastolic velocities, which in contrast to peak systolic velocity also correctly classified thyrotoxic patients. The method can be used before arteriographic evaluation as a screening examination of patients in whom mesenteric ischemia is suspected.