• Family History
  • Pulsatile Abdomen
  • Males over 65
  • Chronic obstructive pulmonary disease (COPD)
  • Previous aneurysm repair or peripheral aneurysm (popliteal or femoral)
  • Coronary Artery Disease
  • Hypertension
  • Marfans Disease
  • Ehlers-Danlos syndrome
  • Collagen Vascular Disease
  • Arteritis
  • Trauma


The patient should be fasted at least 6 hours before.

The study should be performed first thing in the morning.

No smoking.


A curved linear probe 1-4 Mhz with Colour Doppler capabilities.



 A moderate amount of pressure may be needed to push behind the bowel.

The aorta should be imaged in B mode from the diaphragm.

A Grey scale image of the aorta at the largest diameter, noting intraluminal echoes, should be obtained.

The maximal AP and Transverse Diameter are measured in the Proximal, Mid and Distal abdominal aorta.

The maximal AP and Transverse diameters should be measured in the origin of the iliac arteries and if an aneurysm is seen then the scan should be extended to include the common , internal and external iliac arteries .

If an aneurysm is identified ( >3cm in a male and >2.5cm in a female ) then the distance from the renal arteries should be measured . Supra or infra renal should be documented.

If the aneurysm extends into the bifurcation and includes one or both of the iliacs, this should be documented.

Colour duplex  demonstrates the lumen and documents patency of the abdominal aorta. The normal aorta should have a triphasic waveform.

A "heel toe" movement to ensure an angle <60degrees is used for accuracy in any velocity measurements.


 The AP and Transverse measurement  AAA length to renal artery

Normal Transverse B Mode Aorta.

AP and Transverse Diameter should be < 3cm.

Abdominal Aortic Aneurysm distance  to the renal arteries.

Any atherosclerosis should be noted.




Ultrasound of the Mesenteric Arteries - Protocol

Role of Ultrasound

 The role of ultrasound is to assess for any impairment of blood flow within the mesenteric arterial or venous system.

There are 2 Types: Acute and Chronic

Abdominal Angina may be  caused from intermittent mesenteric ischaemia in severe arterial stenosis with inadequate collateralisation. It becomes painful with food ingestion. It is commonly caused by atherosclerosis or occlusion of the CA and/or SMA.


The increased size of the patient , or inability to comfortably hold respiration will limit good visibility of the vessels and performing an accurate spectral trace.

The patients physical and mental status are assessed and monitored for changes in the clinical status during the procedure.

Awareness of anatomical variations is imortant, such as an accessory  or replaced hepatic artery.  Otherwise confusion/incorrect results may arise.

Equipment Selection

A curved linear probe 1-4 Mhz with Colour Doppler capabilities.


Patient Preparation

The patient should be fasted at least 6 hours before.

The study should be performed first thing in the morning.

No smoking.

Patient position

The patient is slightly elevated and supine as the viscera is pulled inferiorly from gravity.



CELIAC ARTERY  (CA) ( Coeliac Artery)

The CA supplies the stomach and duodenum. It is the first artery to branch off the anterior abdominal aorta. It divides into the left gastric , splenic and hepatic arteries.


The CA is seen with the probe transverse. It looks like a "seagull" appearance. It is the division of the hepatic artery and splenic artery.

The probe should be turned longitudinal in a sagittal plane. The CA is seen anterior to the aorta. There can be anatomical variations with the CA vessels having a separate origins.

It is a low resistance waveform as it supllies the liver , spleen and stomach which are low resistance vascular beds. The CA should be assessed with the patient in a semi reclined position. The artery should be sampled with the patient in inspiration , expiration , supine and standing,


The celiac artery is often tortuous so be careful to angle correct.

The CA may share a common trunk with the SMA.

The Hepatic artery may be replaced to SMA or aorta.

Branch vessels arise perpendicular to the celiac axis so are difficult to acquire angles less than 60degrees.

 Seagull Appearance  CA Doppler

B Mode Coeliac Axis

It has a "seagull" appearance with the hepatic artery going towards the liver and the splenic artery to  the left. Anatomical variations can include separate origins of the CA vessels.

Normal Spectral Waveform CA.

Normal Velocity Peak Systolic WAveform 118-200 cm/sec

Normal End diastolic Waveform 30-75 cm/sec

(Moneta et al 1991)




The SMA supplies the jejunum , ileum , Rt and transverse colon.


The SMA origin is immediately below the CA. The left renal vein runs transversley inferior to the SMA between the aorta and SMA.

There may be anatomical variations such as accessory or replaced hepatic artery. The SMA may have the characteristics of the CA as it supplies the Rt hepatic artery.

Patients must be fasted otherwise there may be a low resistance signal.

The SMA may be compressed in the mesentery.

B Mode SMA and CA
 Doppler Normal SMA
SMA B Mode is visualised immediately inferior to the CA in a sagittal view. Doppler of a normal fasted SMA. It is generally not difficult to get an angle <60 degrees. It should be sampled at the origin , prox and distally.

Common Pathology

  • Occlusion and Stenosis of the CA and or SMA
  • Median Arcuate Ligament Compression Syndrome


Basic Hard Copy Imaging

Initially a B-mode scan of the aorta (AO), coeliac axis (CA) and superior mesenteric artery (SMA). Any signs of atherosclerosis are noted and imaged .


3 Spectral traces including Origin , Prox and prebranching into the hepatic and splenic artery.


Critique of images:

  1. Aorta Long
  2. Trans
  3.  Colour  
  4. Doppler Spectral Trace above the CA – Aorta Velocity

Pre and Post Prandial/Mimic any movements that may bring on pain.

  1. CA Long
  2. CA Colour
  3. CA Spectral Trace with Velocity
  4. SMA Long
  5. SMA Colour
  6. SMA Spectral Trace with highest velocity
  7. The IMA.
  8. Any collaterals





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