Abstract No. 416 Two-dimensional perfusion angiography and its suitability in diagnosing and documenting early treatment response in patients with non-occlusive mesenteric ischemia: a retrospective analysis

Abstract

Evaluation of the feasibility of 2D-perfusion angiography (2D-PA) in assessing the intraprocedural treatment response of the splanchnic vessel territory after vasodilatory therapies in patients suffering from non-occlusive mesenteric ischemia (NOMI). 19 procedures in 17 NOMI patients (mean age, 60.9 ± 11 years) were included in this retrospective study. We performed postprocessing of the acquired digital subtraction angiography (DSA) series to evaluate flow and perfusion changes after vasodilatory prostaglandin therapy. We placed target regions of interest (ROIs) in the portal vein, the aorta, and a reference ROI in the superior mesenteric artery (SMA). The peak density (PD), time to peak (TTP) and area under the curve (AUC) were then assessed and the following ratios ‘target ROI (TTP, AUC)/ reference ROI’ computed. Furthermore, the simplified NOMI score was assessed pre- and post-NOMI therapy. Significant changes could be recorded in the individual categories as well as in the overall simplified NOMI score following interventional NOMI therapy (4 to 1, P <0.0001). Both PD and AUC values in the aorta decreased significantly pre- to postinterventionally (PD: P = 0.04; AUC: P = 0.03), while the AUC in the portal vein (PV) was significantly increased (P = 0.04) after prostaglandin application. Though without statistical significance, TTP measured in the PV demonstrated an increase after vasodilator therapy as well (P = 0.13). Our findings are in concordance with the simplified NOMI score. 2D-PA is a suitable method for the analysis of immediate perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable addition to previously published angiographic scoring systems, such as the subjective simplified NOMI score.