Abstract
PurposeThe aim of this prospective study was to validate the diagnostic performance of computed tomography angiography (CTA) in endoprosthesis stenosis in the superior mesenteric artery (SMA) using mean arterial pressure (MAP) gradients during angiography as a reference method.MethodsTwenty-nine patients with mesenteric atherosclerotic disease underwent 45 paired measurements of endoprosthesis stenosis in the SMA with CTA and MAP gradients between March 2009 and July 2015. The grade of endoprosthesis stenosis in the SMA at CTA using the TeraRecon Aquarius workstation was correlated with MAP gradients.ResultsGrade of endoprosthesis stenosis in the SMA (r = 0.37, p = 0.013) correlated with MAP gradients. The intraclass correlations between the first and second CTA rater was 0.76 (95% CI 0.56–0.87) for estimation of grade of endoprosthesis stenosis in the SMA. The area under the receiver operating characteristics curve was 0.79 for diagnosis of significant endoprosthesis stenosis in the SMA at CTA for different threshold values using MAP gradient of ≥ 10 mmHg as reference. Sensitivity, specificity and positive predictive value for endoprosthesis stenosis in the SMA ≥ 50% at CTA were 52.4% (95% CI 31.0–73.7), 87.5% (95% CI 74.3–100.0) and 78.6 (95% CI 57.1–1.00), respectively.ConclusionGrading endoprosthesis stenosis in the SMA with CTA performed fair when using trans-stenotic MAP gradient as reference. Software development towards reduction of endoprosthesis artefacts may result in more accurate CTA assessment of the narrowest part.
Highlights
Endovascular therapy for mesenteric atherosclerotic disease has become an established, minimally invasive method
This study included 45 paired examinations with mean arterial pressure (MAP) gradient and computed tomography angiography (CTA) in 29 patients who were stented in the superior mesenteric artery (SMA) due to acute or chronic mesenteric ischemia
Adjunctive bowel resection to SMA stenting was performed in 6.7% (3/45) in those examined with CTA, compared to 15.0% (6/40) in those not undergoing CTA evaluation (p = 0.21)
Summary
Endovascular therapy for mesenteric atherosclerotic disease has become an established, minimally invasive method. Restenosis within the endoprosthesis develops often with reported re-intervention rate as high as 33% [1], and mortality after acute stent occlusion in the superior mesenteric artery (SMA) has been reported to be 50% [2]. Angiography with measurement of trans-stenotic mean arterial pressure (MAP) gradient during angiography is considered to be the most accurate method for diagnosis of a significant SMA stenosis [1, 3]. Since angiography is invasive and exposes patients and personnel to radiation, the European Society of Vascular Surgery (ESVS) recommend colour Doppler ultrasound (CDU) of the mesenteric arteries as first line examination [4] and performance of CDU when using MAP gradient as a reference was recently found to be good [5]. The diagnostic performance of CTA for evaluation of endoprosthesis stenosis in the SMA using a modern software tool is unknown
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