Defining Duplex Ultrasound Criteria for In-Stent Restenosis of the Superior Mesenteric Artery

被引:3
|
作者
Green, Jessica [1 ]
Ryer, Evan [1 ]
Borden, Nicholas [1 ]
Ali, Bilal [1 ]
Garvin, Robert [1 ]
Yang, Andrew [1 ]
Hashmi, Ammar [1 ]
Salzler, Gregory [1 ]
Elmore, James [1 ]
机构
[1] Geisinger Med Ctr, Dept Endovasc & Vasc Surg, Danville, PA 17822 USA
关键词
FOLLOW-UP; ISCHEMIA; STENOSIS; REVASCULARIZATION;
D O I
10.1016/j.avsg.2020.12.023
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: This study sought to define duplex ultrasound (DUS) velocity cr iter ia predicting >70% stenosis in superior mesenteric artery (SMA) stents by correlating in-stent peak systolic velocity (PSV) with computed tomographic angiography (CTA) measurements of percent stenosis. Methods: A retrospective review of 109 patients undergoing SMA stenting between 2003 and 2018 was conducted at a single institution. Thirty-seven surveillance duplex ultrasound studies were found to have a CTA performed within 30 days of study completion. Bare metal ( n = 20) and covered stents ( n = 17) were included. Velocities were paired to in-stent restenosis (ISR) measured by mean vessel diameter reduction on SMA centerline reconstructions from CTA. Receiver operating characteristic (ROC) curves was generated and logistic regression models for >70% ISR probability were used to define velocity cr iter ia in the stented SMA. Results: At a PSV of 300 cm/sec, the sensitivity is 100% and specificity 80% for a >70% instent SMA stenosis. At a PSV of 400 cm/sec, the sensitivity and positive predictive value (PPV) is 63% and the specificity and negative predictive value (NPV) is 90%. A PSV of 450 cm/sec was consistent with the highest specificity (100%) and PPV (100%) but lower sensitivity (50%) and NPV (87.9%). One patient with a PSV of 441 cm/sec on surveillance DUS died from complications of acute-on-chronic mesenteric ischemia. Conclusions: A PSV of 400 cm/sec on mesenteric DUS can predict >70% ISR with high sensitivity and should be considered as a diagnostic threshold for SMA in-stent restenosis.
引用
收藏
页码:294 / 300
页数:7
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