DIAGNOSIS OF EXTRAVASAL CELIAC ARTERY COMPRESSION BY DUPLEX SCANNING

S.O. Romashin, V.P. Kulikov, V.B. Gervaziev, V.G. Lubyansky
Chair of Pathophysiology and Functional Diagnosis, Chair of Hospital Surgery,
Altai State Medical University, Department of Ultrasound Diagnosis,
Altai Diagnostic Centre,
Barnaul, Russia

The aim of the present work was to study celiac artery hemodynamics in patients with abdominal pain syndrome (APS) and to derive on this basis ultrasound criteria for the diagnosis of celiac artery compression syndrome. 54 patients with APS aged 17-58 years and 16 normal subjects aged 26-28 years which constituted the control group were examined. The blood flow in the celiac artery (CA) and lienal artery (LA) were examined in the deep inhalation and expiration phases with breath holding. It has been established that in normal subjects, the blood flow acceleration in the CA in the deep expiration phase by 35.6±5.9% on the average was the natural physiological reaction of hemodynamics to respiratory movements. This reaction may be the result of the physiological narrowing of the CA lumen because of the influence of the median arcuate ligament of the diaphragm. It was found to be especially demonstrable in asthenic subjects. As compared to normal subjects, some patients presenting with APS showed essential differences in the hemodynamic reaction of the CA and LA to respiratory movements. These differences were marked by a more powerful (comparatively to normals) and an unequal increase in the deep expiration phase of the Vmax and Vmin in the CA (80.2±7.8% and 113.2±6.7%, respectively). At the same time there was a natural decrease in the indices of peripheral resistance: PI dropped by 60.4±5.5%, RI by 29.1±3.5%, S/D ratio by 44,9±4.1% as compared to those recorded in the deep inhalation phase. Moreover, these patients demonstrated a remarkable spectral broadening in the CA in the expiration phase. Angular deformation of the CA in the cranial direction was also visualized in the deep expiration phase with emergence of an aliasing effect. In contrast to normals, the same patients were found to have alterations in the lienal artery blood flow. Thus, as compared to inhalation, the deep expiration phase was associated with a decrease of Vmax by 49.8±8.6% whereas Vmin did not show any significant changes. At the same time PI was recorded to decrease by 57.3±5.5%, RI by 31.3±3.1%, S/D ratio by 37.3±2.8% with respect to the inhalation phase. In the deep expiration phase, the acceleration time in the CA was also found to be longer by 73.7±3.1% as compared to the inhalation phase. Surgical correction of celiac artery compression (CAC) made the blood flow in the CA and LA return to normal. Color duplex scanning can be used for CAC identification and control of the hemodynamic efficacy of its surgical treatment.

KEY WORDS: Extravasal celiac artery compression, abdominal pain syndrome.

P. 25-32

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