ABC | Volume 112, Nº6, June 2019

Statement Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(6):809-849 Table 12 – General limitations of vascular ultrasound in the evaluation of abdominal aorta and branches Aorta and iliacs Mesenteric arteries/Celiac trunk Renal arteries ● Hostile abdomen ● Hostile abdomen ● Hostile abdomen ● Obesity ● Obesity ● Obesity ● Intestinal meteorism ● Intestinal meteorism ● Intestinal meteorism ● Examiner-dependent ● Patient with severe abdominal pain – in acute ischemia ● Anatomic changes ● Low-quality equipment ● Examiner-dependent ● Examiner-dependent ● Low-quality equipment ● Low-quality equipment Mesenteric artery obstructive disease progresses chronically and asymptomatically. The clinical manifestation represented by postprandial abdominal pain (mesenteric angina) and/or progressive weight loss occurs when two or more mesenteric vessels are involved. Older men are more frequently affected. Atherosclerosis is responsible for more than 90% of diseases Figure 10 – Abdominal aorta and branches. SA: splenic artery; HA: hepatic artery; RCIA: right common iliac artery; LCIA: left common iliac artery; IMA: inferior mesenteric artery; RRA: right renal artery; LRA: left renal artery; SMA: superior mesenteric artery; CT: celiac trunk. HA RRA RCIA CT SA SMA LRA IMA LCIA that strike mesenteric arteries and is usually dissemination of the atheromatous process that involves the entire aorta. 36 Arteriography is the standard diagnostic method; however, VUS is the first examination indicated for the study of symptomatic chronic intestinal ischemia for being non-invasive and risk-free. 37 The objective of VUS is to determine the presence, location, extension, and severity of the stenotic lesion. The study must include the SMA, CT, and IMA, with the evaluation of SMA and CT being more important. 38 3.3.2. Clinical Indications • Recurrent postprandial abdominal pain (mesenteric angina). • Weight loss without a known cause. • Abdominal bruit. The DCI recommendations describe in detail the protocols of follow-up after surgical or endovascular treatment and assessment of compression syndromes. 2 3.3.3. Examination Preparation and General Protocol (Table 10) • Specific examination protocol: 39,40 - Place the transducer in the epigastric region; using the transverse plane, identify the SMA anteriorly, the aorta posteriorly, and the right renal vein between these two vessels (Figure 11A). In this same location, using the longitudinal plane of the aorta, find the CT and SMA (Figure 11B). - B-scan: evaluates the presence of atherosclerotic or aneurysmal disease. - Color flow imaging: assesses vessel patency and indicates flow turbulence, suggesting the probable stenosis site. - Spectral analysis: used to analyze PSV and EDV. Measure these velocities in the origin of the vessel and/or in places with suspicion of stenosis. Position the insonation angle toward the blood flow. - Velocities of mesenteric vessels are influenced by respiration; therefore, patients should hold their breath during the measurement. 825