Mesenteric Duplex: PSV Thresholds for Celiac Trunk and SMA in Chronic Ischemia
PSV Thresholds for Significant Stenosis
According to duplex diagnostic rules, a significant (≥70%) stenosis of visceral arteries is determined by the following velocity criteria (classic Moneta/SVS thresholds and refined AbuRahma 2012):
| Artery | PSV (classic) | PSV (refined AbuRahma 2012) | Additional |
|---|---|---|---|
| SMA | ≥275 cm/s | ≥400 cm/s | EDV >45 cm/s is informative for >50% |
| CA (celiac trunk) | ≥200 cm/s | ≥320 cm/s | — |
A PSV threshold >275 cm/s for the SMA is associated with >70% stenosis (Diagnostic Ultrasound Vascular). Additional signs of significant stenosis include post-stenotic turbulence and dilation, high EDV, and a narrow jet of accelerated flow at the origin on color Doppler imaging.
Consideration of Respiratory Phase
PSV and EDV in the celiac artery and SMA are significantly higher during exhalation than inhalation — this is a physiological effect related to diaphragm movement and compression of visceral arteries (van Petersen 1998; ESVS 2025 amendment). Measure velocities in a comparable respiratory phase; without specifying the phase, figures in the mesenteric zone are meaningless. For the celiac artery, always document velocities in both phases (exhalation and inhalation) and the exhalation/inhalation ratio.
Clinical Context of CMI
The clinical presentation of chronic mesenteric ischemia usually requires involvement of ≥2 out of 3 arteries (more commonly CA + SMA). At high velocities in the CA, respiratory compression (MALS) should be excluded. Confirmation of significant stenosis is performed via CTA (ESVS 2025).
Compensatory Blood Flow and Indirect Signs
Elevated velocities may be observed in a normal mesenteric artery due to compensatory blood flow resulting from critical stenosis or occlusion of a paired visceral vessel: for example, in critical stenosis/occlusion of the celiac artery, blood flow and velocity in the SMA often increase. An indirect sign of proximal obstruction is retrograde blood flow in the common hepatic artery or its branches (collateral flow).
Documented Parameters
Minimum set: PSV/EDV in CA, SMA (and IMA if necessary), CA/Ao ratio, deviation angle of the CA trunk, condition of branches. The study is performed fasting — a mandatory condition. Description formulation: number + location + condition, with mandatory indication of the respiratory phase.
Frequently asked questions
What PSV indicates a significant (≥70%) stenosis of the SMA?
PSV ≥275 cm/s (refined ≥400 cm/s), plus post-stenotic turbulence; EDV >45 cm/s is informative for stenosis >50%.
What are the PSV thresholds for the celiac artery?
Significant (≥70%) stenosis of CA: PSV ≥200 cm/s (classic Moneta/SVS), refined ≥320 cm/s (AbuRahma 2012).
Why is it necessary to consider the respiratory phase?
PSV and EDV in CA and SMA are significantly higher during exhalation due to diaphragm movement and artery compression. Velocities are measured in a comparable phase; for CA, document exhalation, inhalation, and the exhalation/inhalation ratio.
How many arteries need to be affected for CMI clinical presentation?
Usually, involvement of ≥2 out of 3 arteries is required, more commonly CA + SMA.
How to distinguish CA stenosis from respiratory compression?
At high velocities in CA, MALS is excluded; during inhalation, velocities decrease but do not normalize. Confirmation of significant stenosis is via CTA (ESVS 2025).