Application of duplex ultrasound imaging in determining in-stent stenosis during surveillance after mesenteric artery revascularization Aaron C. Baker,

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Application of duplex ultrasound imaging in determining in-stent stenosis during surveillance after mesenteric artery revascularization Aaron C. Baker, MS, MD, Victoria Chew, BS, Chin-Shang Li, PhD, Tzu-Chun Lin, MS, David L. Dawson, MD, William C. Pevec, MD, Nasim Hedayati, MD Journal of Vascular Surgery Volume 56, Issue 5, Pages 1364-1371 (November 2012) DOI: 10.1016/j.jvs.2012.03.283 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 A dot plot shows superior mesenteric artery (SMA) peak systolic velocities (PSVs) before and after stenting of the native SMA. Poststenting surveillance was performed at an average of 0.9 ± 1.5 months (range, 0-8 months). The in-stent SMA PSV was elevated in two patients (dotted lines) and reintervention was recommended. One patient (shown as X) who had a pre-SMA stenting duplex ultrasound assessment was converted to an open procedure before the poststenting duplex ultrasound surveillance. Journal of Vascular Surgery 2012 56, 1364-1371DOI: (10.1016/j.jvs.2012.03.283) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Mean peak systolic velocities (PSVs) of the superior mesenteric artery (SMA) before and after stenting of the native SMA during duplex ultrasound (DUS) surveillance. A significant decrease occurs from prestent to the first poststent with DUS surveillance performed at 0.9 months (P < .05). No significant difference exists between the in-stent SMA PSV at 0.9, 4.8, and 14.4 months (P > .05). In-stent SMA PSVs on average remain >275 cm/s. Journal of Vascular Surgery 2012 56, 1364-1371DOI: (10.1016/j.jvs.2012.03.283) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 A, The change in the in-stent superior mesenteric artery (SMA) peak systolic velocity (PSV) from baseline (in-stent SMA surveillance duplex ultrasound imaging) demonstrates the in-stent SMA PSV guiding reintervention for seven reintervention procedures (baseline data not available for one procedure, shown as a pink dot). B, Shown are the changes of the in-stent SMA PSVs after reintervention for in-stent stenosis for eight procedures. Reintervention resulted in a significant decrease in the average in-stent SMA PSV (P < .05). Journal of Vascular Surgery 2012 56, 1364-1371DOI: (10.1016/j.jvs.2012.03.283) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 During duplex ultrasound (DUS) surveillance after stenting of both the superior mesenteric artery (SMA) and the celiac artery (CA), occlusion of the CA stent resulted in a concomitant increase of the in-stent SMA peak systolic velocity, despite angiographic patency. Reintervention on the CA stent only resulted in a subsequent decrease of the in-stent SMA PSV. Journal of Vascular Surgery 2012 56, 1364-1371DOI: (10.1016/j.jvs.2012.03.283) Copyright © 2012 Society for Vascular Surgery Terms and Conditions