Asymptomatic celiac and superior mesenteric artery stenoses are more prevalent among patients with unsuspected renal artery stenoses

Abstract

The prevalence of unsuspected renal artery stenosis among patients with peripheral vascular disease has been reported to be as high as 40%, but the prevalence of asymptomatic celiac and superior mesenteric artery stenoses in these patients is not known. The biplane aortograms of 205 male patients who were military veterans and had aneurysms or occlusive disease were independently reviewed, and medical records were studied to determine associated coronary disease, risk factors, and patient outcome. Fifty-six patients (27%) had a 50% or greater stenosis in the celiac or superior mesenteric artery, and seven patients (3.4%) had significant stenoses in both mesenteric arteries. Patients with celiac or superior mesenteric artery stenoses were older (p = 0.002) and had a higher prevalence of hypertension (p = 0.029) than those without significant mesenteric stenoses. Fifty of the 205 patients had significant renal artery stenoses, and 20 had advanced (greater than 75% diameter loss) renal stenoses. Ten of the 20 patients (50%) with advanced renal stenoses had a concomitant celiac artery stenosis, compared to 40 of the 185 patients (22%) who did not have advanced renal stenoses (p = 0.011). In the present study asymptomatic celiac or superior mesenteric artery stenoses were common among male veterans evaluated for peripheral vascular disease, but the prevalence of significant stenoses in both the celiac and superior mesenteric arteries was low. The prevalence of significant celiac stenosis was higher in patients with advanced (greater than 75%) renal artery stenoses who might be considered for prophylactic renal revascularization. Lateral aortography with evaluation of the celiac artery is always appropriate in these patients.

Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography.

“…This study shows that the fnequency of asymptomatic stenoses in the celiac artery and superior mesentenic artery in the elderly population is high (18%) but is less than the 27% reported in patients with peripheral vascular disease [8]. However, genuine chronic mesentenic ischemia is thought to be rare [9].…”

Diagnosis and management of splanchnic ischemia

“…In a screening study with duplex ultrasonography in 553 healthy elderly subjects with a mean age of 84 years, stenoses in the celiac artery (CA) or superior mesenteric artery (SMA) were found in 18% [10] . In patients with atherosclerotic disorders of aorta, iliac and femoral vessels the incidence ranged from 25% to 40% [11,12] . A minority of patients with CSD will develop CSS or acute splanchnic syndrome (ASS).…”

The prevalence and distribution of the atherosclerotic plaques in the abdominal aorta and its branches

“…The prevalence and volume of the plaques increased with age in both sexes [23][24][25]29]. In the CORD study, calcification scores increased rapidly with age [15].…”

“…They studied the moderate and the severe groups and found that stenosis occurred more frequently in CT (96%) than in the SMA (50%) and IMA (57%) [27]. Valentine et al [29] used the same method for the classification of the degree of arterial stenosis; 27% of the 205 male patients had at least one severe mesenteric artery stenosis, 25% had severe stenosis in CT, 6% had severe stenosis in SMA and 24% had moderate and 40% of them had severe renal artery stenosis.…”