Integrated ultrasound for early diagnosis of visceral ischemic syndrome

Aim. To study the incidence of unpaired visceral arteries occlusive disease and clinical types of visceral ischemic syndrome in patients with persistent abdominal pain. Methods. The study included 326 patients with chronic atrophic gastritis and duration of abdominal pain over 3 months. The first group included 184 patients with inflammatory conditions. The second group consisted of 142 patients with visceral ischemic syndrome associated with visceral arteries stenosis. The mean age of patients with inflammatory conditions did not exceeded 60 years, and duration of abdominal pain syndrome was less than 6 months. In patients with visceral ischemic syndrome, patients’ age was over 60 years, and abdominal pain persisted for more than 12 months (p <0.01). All patients underwent an integrated ultrasonography and two-staged functional Doppler ultrasonography of visceral arteries. Results. At endoscopy, atrophic gastritis was associated with atrophic colitis and bowel motility disorders in 14.7-15.3% of patients with visceral ischemic syndrome and in 2.1% of patients with inflammatory conditions (p <0.001). On Doppler, 53.5% of patients with visceral ischemic syndrome had clinical picture of subcompensated celiac trunk arterial insufficiency (36.8%) or a combination of two visceral artery diseases (13.2-18.4%). 46.5% of patients with visceral ischemic syndrome had clinical signs of decompensated visceral arteries chronic arterial insufficiency caused by external compression (69.7%) or atherosclerosis (30.3%). The classification of ultrasonic stages of visceral ischemic syndrome was developed, which allows optimizing patients’ follow-up, treatment tactics and better assessing their effectiveness. Conclusion. Integrated ultrasound of visceral arteries revealed visceral arteries disease in 43.6% of patients with persistent abdominal pain, as well as the stage and degree of the disease. In 46.5% of visceral ischemic syndrome cases, arterial stenosis was diagnosed, and in 53.5% of cases - functionally reduced visceral blood flow.

atherosclerosis, stenosis of abdominal aorta unpaired visceral branches, visceral ischemic syndrome