Use of hemodynamic parameters in the diagnosis of mesenteric insufficiency

To evaluate the hemodynamic characteristics of the normal mesenteric circulation, five parameters of the velocity waveforms were measured in 15 normal subjects in the celiac and superior mesenteric arteries (SMA) in the pre- and postprandial periods. It was noted that changes in celiac artery flow after eating was minimal, indicating that this vessel's major supply function is not to the gut. SMA parameters showing the most significant and consistent changes after a meal were the diastolic reverse flow and diastolic forward flow (DFF). Four patients referred with symptoms of intestinal angina underwent scanning and subsequent angiography of their mesenteric circulation. All four exhibited loss of reverse flow in the SMA. The change in DFF in the SMA was statistically significant (p = 0.01). Change in peak systolic velocity in the celiac artery was marginally significant (p = 0.05). Angiography revealed that three patients had greater than 90% stenosis of both vessels. The fourth patient had a 90% celiac artery and 65% SMA stenosis. The technique described offers the first noninvasive means of identifying mesenteric insufficiency. It is an effective screening method for a disease entity difficult to verify without selective arteriography. The use of velocity waveform parameters giving good discrimination between normal subjects and those with stenoses of the visceral arteries should reduce both the incidence of missed diagnosis and unnecessary angiography.