Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries
Abstract Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity c...
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| Veröffentlicht in: | Journal of vascular surgery 2016-11, Vol.64 (5), p.1366-1372 |
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| creator | Soult, Michael C., MD Wuamett, Joseph C., MD Ahanchi, S. Sadie, MD Stout, Christopher L., MD Larion, Sebastian, MD Panneton, Jean M., MD, FACS, FRCSC |
| description | Abstract Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. Methods A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination |
| doi_str_mv | 10.1016/j.jvs.2016.06.103 |
| format | Article |
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Sadie, MD ; Stout, Christopher L., MD ; Larion, Sebastian, MD ; Panneton, Jean M., MD, FACS, FRCSC</creator><creatorcontrib>Soult, Michael C., MD ; Wuamett, Joseph C., MD ; Ahanchi, S. Sadie, MD ; Stout, Christopher L., MD ; Larion, Sebastian, MD ; Panneton, Jean M., MD, FACS, FRCSC</creatorcontrib><description>Abstract Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. Methods A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination <4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR. Results There were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with <70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with <70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%. Conclusions Increasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2016.06.103</identifier><identifier>PMID: 27633165</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Angiography ; Area Under Curve ; Blood Flow Velocity ; Celiac Artery - diagnostic imaging ; Celiac Artery - physiopathology ; Constriction, Pathologic ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Female ; Humans ; Male ; Mesenteric Artery, Superior - diagnostic imaging ; Mesenteric Artery, Superior - physiopathology ; Mesenteric Vascular Occlusion - diagnostic imaging ; Mesenteric Vascular Occlusion - physiopathology ; Mesenteric Vascular Occlusion - therapy ; Middle Aged ; Predictive Value of Tests ; Recurrence ; Reproducibility of Results ; Retrospective Studies ; ROC Curve ; Splanchnic Circulation ; Stents ; Surgery ; Time Factors ; Ultrasonography, Doppler, Duplex ; Vascular Patency ; Virginia</subject><ispartof>Journal of vascular surgery, 2016-11, Vol.64 (5), p.1366-1372</ispartof><rights>Society for Vascular Surgery</rights><rights>2016 Society for Vascular Surgery</rights><rights>Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c521t-726f5570729949eb453f376d36c312f47a0eb8ba3435554e5b41a041afb0a9393</citedby><cites>FETCH-LOGICAL-c521t-726f5570729949eb453f376d36c312f47a0eb8ba3435554e5b41a041afb0a9393</cites><orcidid>0000-0003-1498-7216</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jvs.2016.06.103$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27633165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soult, Michael C., MD</creatorcontrib><creatorcontrib>Wuamett, Joseph C., MD</creatorcontrib><creatorcontrib>Ahanchi, S. Sadie, MD</creatorcontrib><creatorcontrib>Stout, Christopher L., MD</creatorcontrib><creatorcontrib>Larion, Sebastian, MD</creatorcontrib><creatorcontrib>Panneton, Jean M., MD, FACS, FRCSC</creatorcontrib><title>Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Abstract Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. Methods A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination <4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR. Results There were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with <70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with <70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%. Conclusions Increasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Area Under Curve</subject><subject>Blood Flow Velocity</subject><subject>Celiac Artery - diagnostic imaging</subject><subject>Celiac Artery - physiopathology</subject><subject>Constriction, Pathologic</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Mesenteric Artery, Superior - diagnostic imaging</subject><subject>Mesenteric Artery, Superior - physiopathology</subject><subject>Mesenteric Vascular Occlusion - diagnostic imaging</subject><subject>Mesenteric Vascular Occlusion - physiopathology</subject><subject>Mesenteric Vascular Occlusion - therapy</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Recurrence</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Splanchnic Circulation</subject><subject>Stents</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Ultrasonography, Doppler, Duplex</subject><subject>Vascular Patency</subject><subject>Virginia</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UU1v1TAQtBAVfRR-ABeUI5e87vozERISavmoVIkDcLYcZyM55MUPO6naf19Hr3DgwMEaazQz2p1l7A3CHgH15bgf7_Kel-8edKHEM7ZDaE2tG2ifsx0YibXiKM_Zy5xHAETVmBfsnBstBGq1YzfX63Gi-2qdluRyXOe-8ikslIKrhpiqMNd5oXmpEm0Yc8hVHKoD5UIWla9c2pDyK3Y2uCnT6ye8YD8_f_px9bW-_fbl5urjbe3LJEttuB6UMmB428qWOqnEIIzuhfYC-SCNA-qazgkplFKSVCfRQXlDB64Vrbhg7065xxR_r2UqewjZ0zS5meKaLTZC6YYr0EWKJ6lPMedEgz2mcHDpwSLYrUE72tKg3Rq0oAsliuftU_zaHaj_6_hTWRG8PwmoLHkXKNnsA82e-pDIL7aP4b_xH_5x-ynMwbvpFz1QHuOa5tKeRZu5Bft9O-F2QdQCGolcPAKAtJWY</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Soult, Michael C., MD</creator><creator>Wuamett, Joseph C., MD</creator><creator>Ahanchi, S. Sadie, MD</creator><creator>Stout, Christopher L., MD</creator><creator>Larion, Sebastian, MD</creator><creator>Panneton, Jean M., MD, FACS, FRCSC</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1498-7216</orcidid></search><sort><creationdate>20161101</creationdate><title>Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries</title><author>Soult, Michael C., MD ; Wuamett, Joseph C., MD ; Ahanchi, S. Sadie, MD ; Stout, Christopher L., MD ; Larion, Sebastian, MD ; Panneton, Jean M., MD, FACS, FRCSC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c521t-726f5570729949eb453f376d36c312f47a0eb8ba3435554e5b41a041afb0a9393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography</topic><topic>Area Under Curve</topic><topic>Blood Flow Velocity</topic><topic>Celiac Artery - diagnostic imaging</topic><topic>Celiac Artery - physiopathology</topic><topic>Constriction, Pathologic</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Mesenteric Artery, Superior - diagnostic imaging</topic><topic>Mesenteric Artery, Superior - physiopathology</topic><topic>Mesenteric Vascular Occlusion - diagnostic imaging</topic><topic>Mesenteric Vascular Occlusion - physiopathology</topic><topic>Mesenteric Vascular Occlusion - therapy</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Recurrence</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Splanchnic Circulation</topic><topic>Stents</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Ultrasonography, Doppler, Duplex</topic><topic>Vascular Patency</topic><topic>Virginia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soult, Michael C., MD</creatorcontrib><creatorcontrib>Wuamett, Joseph C., MD</creatorcontrib><creatorcontrib>Ahanchi, S. Sadie, MD</creatorcontrib><creatorcontrib>Stout, Christopher L., MD</creatorcontrib><creatorcontrib>Larion, Sebastian, MD</creatorcontrib><creatorcontrib>Panneton, Jean M., MD, FACS, FRCSC</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soult, Michael C., MD</au><au>Wuamett, Joseph C., MD</au><au>Ahanchi, S. Sadie, MD</au><au>Stout, Christopher L., MD</au><au>Larion, Sebastian, MD</au><au>Panneton, Jean M., MD, FACS, FRCSC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>64</volume><issue>5</issue><spage>1366</spage><epage>1372</epage><pages>1366-1372</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Abstract Objective Duplex ultrasound (DUS) criteria are well defined for evaluating high-grade stenosis (≥70%) of the native superior mesenteric artery (SMA) and celiac artery (CA). It has been shown that native vessel criteria overestimate the degree of in-stent restenosis (ISR) and that velocity criteria for SMA and CA ISR are not well established. The objective of this study was to define DUS velocity criteria for high-grade ISR of the SMA and CA. Methods A retrospective review of all patients who underwent SMA or CA stenting from a single institution was performed from 2004 to 2013. Patients were excluded if they did not have a DUS examination <4 months before angiography to assess stent patency or adequate angiographic visualization of the ISR. Results There were 103 paired DUS scans and angiograms analyzed: 66 SMA studies and 37 CA studies. The average peak systolic velocity (PSV) for SMAs was 367 cm/s with <70% ISR and 536 cm/s with ≥70% ISR. The average PSV for CAs was 302 cm/s with <70% ISR and 434 cm/s with ≥70% ISR. For an ISR ≥70% in the SMA, a PSV ≥445 cm/s produced the highest sensitivity (83%) and specificity (83%), with a positive predictive value of 81% and a negative predictive value of 86%. For an ISR ≥70% in the CA, a PSV ≥289 cm/s produced the highest sensitivity (100%) and specificity (57%), with a positive predictive value of 79% and negative predictive value of 100%. Conclusions Increasing PSV correlates with an increasing degree of ISR for both the SMA and CA. Stented vessels have increased PSV, and therefore native PSV criteria are unreliable for the determination of ISR. The PSV criteria for ≥70% stenosis are higher for ISR than for native visceral vessel stenosis. The proposed new velocity criteria define ≥70% ISR as ≥445 cm/s in stented SMAs and ≥289 cm/s in stented CAs.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27633165</pmid><doi>10.1016/j.jvs.2016.06.103</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1498-7216</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Angiography Area Under Curve Blood Flow Velocity Celiac Artery - diagnostic imaging Celiac Artery - physiopathology Constriction, Pathologic Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Female Humans Male Mesenteric Artery, Superior - diagnostic imaging Mesenteric Artery, Superior - physiopathology Mesenteric Vascular Occlusion - diagnostic imaging Mesenteric Vascular Occlusion - physiopathology Mesenteric Vascular Occlusion - therapy Middle Aged Predictive Value of Tests Recurrence Reproducibility of Results Retrospective Studies ROC Curve Splanchnic Circulation Stents Surgery Time Factors Ultrasonography, Doppler, Duplex Vascular Patency Virginia |
| title | Duplex ultrasound criteria for in-stent restenosis of mesenteric arteries |
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