Algorithm for celiac artery compression syndrome

CT: computed tomography; MR: magnetic resonance; SMA: superior mesenteric artery.
* Patient should not otherwise have clinical features of chronic mesenteric ischemia due to peripheral artery disease (ie, smoking, claudication).
¶ Cross-sectional CT or MR, or CT or MR angiography. For patients with clear-cut intestinal angina, duplex ultrasound is an alternative initial study to evaluate for celiac artery stenosis.
Δ Without an identifiable intraluminal cause for stenosis (eg, atherosclerosis, embolism) and without concomitant intraluminal SMA stenosis.
◊ The diagnosis can be confirmed by either positive findings on catheter-based arteriography that includes lateral views or by a combination of anatomic findings on CT or MR angiography combined with appropriate respiratory variations on duplex ultrasound.
§ Open surgical or minimally invasive robotic-assisted or laparoscopic surgery.
¥ Intraoperative duplex ultrasound or arteriography.
‡ Ensure that release is complete prior to angioplasty/stenting.