Endovascular management of acute and chronic arterial mesenteric ischaemia: A narrative review of evidence informing interventional radiology treatment

Table 2 Imaging modalities in chronic arterial mesenteric ischaemia

Modality	Principal role	Strengths	Limitations and practical considerations	Ref.
DUS	Initial screening in experienced centres	Non-invasive assessment of proximal CA and SMA anatomy and flow velocities without radiation or intravenous contrast	Requires fasting and expertise; affected by bowel gas, body habitus and respiration. Positive or inconclusive results require CTA or MRA confirmation	[3,81,82,85]
CTA	Preferred examination for anatomical confirmation and treatment planning	Defines stenosis, lesion length, calcification, vessel origins and collaterals; evaluates alternative causes of symptoms	Iodinated contrast and radiation exposure. Anatomical stenosis alone does not establish symptomatic CMI	[3,84,85,87]
MRA	Alternative when CTA is contraindicated	Contrast-enhanced assessment of proximal mesenteric stenoses without radiation; specialised techniques permit flow assessment	Longer acquisition and motion artefact; smaller vessels less reliably assessed and stenosis may be overestimated. Gadolinium suitability requires individual assessment	[3,85,87,90,91]
DSA	Generally reserved for endovascular intervention	Detailed vascular and collateral assessment with concurrent treatment; selective pressure measurements may help assess uncertain lesions	Invasive; contrast, radiation and access-site risks. Pressure measurements are adjunctive and do not independently establish CMI	[3,85,92,93]

CA: Coeliac artery; CMI: Chronic mesenteric ischaemia; CTA: Computed tomography angiography; DSA: Digital subtraction angiography; DUS: Duplex ultrasound; MRA: Magnetic resonance angiography; SMA: Superior mesenteric artery.