Clinical usefulness with the combination of color Doppler and contrast-enhanced harmonic EUS for the assessment of visceral vascular diseases.

GOALS: To evaluate the clinical usefulness of the color Doppler and contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) in diagnosing visceral vascular diseases and in assessing morphologic and hemodynamic characteristics required for optimized patient management.

BACKGROUND

Mesenteric arteries are easily accessible with EUS because of its proximities to the gastrointestinal tract.

STUDY: EUS was performed in 12 patients with clinically suspected visceral vascular disease, as determined by computed tomography (CT) scan between February 2012 and March 2013. Conventional B-mode, color Doppler, and CEH-EUS was performed to evaluate vascular status of the celiac artery and superior mesenteric artery (SMA).

RESULTS

CT scan imaging suggested arterial dissection in 9 patients; arterial stenosis or occlusion in 2 patients, and periarterial soft tissue cuffing in 1 patient. EUS accurately identified all the visceral vascular lesions of 11 patients and 1 patient with suspected SMA dissection on CT imaging was proven to be normal by EUS. EUS also identified one undefined dissection not detected on abdominal CT. EUS examination revealed vascular intimal flap in 5 patients and blood flow within the true lumen and thrombi within the false lumen in 8 patients. In addition, the stenotic area could be calculated using color Doppler EUS. Two patients underwent surgical thrombectomy and angioplasty because of total occlusion of SMA on color Doppler and CEH-EUS.

CONCLUSIONS

The combination of color Doppler and CEH-EUS may be a promising diagnostic modality to assess the splanchnic artery without exposure to radiation. Moreover, EUS is a useful tool to determine the appropriate treatment options for patients with isolated mesenteric artery dissection.