Abstract
Dr. Blebea makes three points with which we totally agree. The first, as was emphasized in our original article, is that the detection of mesenteric stenosis does not necessarily imply a diagnosis of chronic intestinal ischemia. The second is that retrospectively derived diagnostic criteria require prospective validation. Third, predictive values based on sensitivities and specificities determined in one population may not be the same when applied to a second population with a different prevalence of disease. These last two points are well known to those of us interested in the evaluation of noninvasive testing methods but periodically deserve reemphasis. On the subject of the second point, we are sure Dr. Blebea heard us present our paper at the recent Society for Vascular Surgery. meeting in Chicago in which we reported a blinded prospective evaluation of our criteria for duplex determination of celiac artery and superior mesenteric artery stenosis. It is interesting to note that of the 100 patients reported in this prospective evaluation, 13 were evaluated for chronic intestinal ischemia, and four (31%) were treated with intestinal revascularization, which suggests, at least in our patient population, the proportion of patients who were believed to have chronic intestinal ischemia and were referred to a vascular surgeon may be higher than 10%. We encourage individual laboratories to use our criteria for diagnosing mesenteric stenosis in their patients and to evaluate its efficacy. If our criteria for splanchnic stenosis are not found to be effective in a particular institution because of either technical reasons or a lower prevalence of disease than exists in our patients, we hope local investigators will have the initiative to put forth new criteria for evaluation.
Published Version
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