A 62-year-old woman reports postprandial abdominal pain and fear of eating. She has lost 8 kg. Duplex ultrasound of the splanchnic vessels is performed while fasting. Which velocity criterion supports the diagnosis of significant mesenteric arterial disease?

• A Peak systolic velocity greater than 150 cm/s in the coeliac axis
• B Peak systolic velocity greater than 275 cm/s in the superior mesenteric artery ✓
• C End diastolic velocity greater than 100 cm/s in the inferior mesenteric artery
• D Peak systolic velocity less than 100 cm/s in the superior mesenteric artery

Explanation

The widely used duplex thresholds for chronic mesenteric ischaemia are a fasting peak systolic velocity of 275 cm/s or more in the superior mesenteric artery and 200 cm/s or more in the coeliac axis, indicating haemodynamically significant stenosis. Diagnosis also requires symptoms in at least two of the three mesenteric territories being diseased. Low velocities indicate proximal occlusion or normal flow, not stenosis, and the inferior mesenteric artery is not part of the standard criteria.

Reference: Brant and Helms Fundamentals of Diagnostic Radiology, 5th ed.

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