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Mesenteric arterial disease

Case contributed by Brendan Cullinane
Diagnosis probable

Presentation

Patent referred for surveillance of aortic endovascular graft.

Patient Data

Gender: Male
ultrasound

The celiac axis origin appear significantly narrowed on b-mode imaging. Peak systolic velocities are significantly elevated suggesting a high-grade >70% stenosis.

The superior mesenteric artery origin appears narrowed and has an acute take-off. There appears to be post-stenotic dilatation. Peak systolic velocities within the stenotic segment are significantly elevated suggesting a >70% stenosis.

Case Discussion

This patient had endovascular repair of an abdominal aortic aneurysm. Aliasing of the celiac axis and proximal superior mesenteric artery was noted on colout Doppler assessment of the graft. B-mode imaging indicated significant stenoses of these vessels graded at >70% by spectral Doppler analysis.

The patient was asymptomatic for mesenteric ischemia. However he is at risk as both the celiac axis and superior mesenteric artery are stenosed.

Post-prandial scanning to assess for the level of velocity increase after food ingestion was not performed due to time constraints and lack of symptoms.

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