Abdominal Angina Workup

Updated: May 25, 2022
  • Author: Faisal Aziz, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Laboratory Studies

No laboratory tests are diagnostic of abdominal angina. Usually, nutritional parameters are suggestive of malnutrition. If malignancy or gastric ulcer disease is suspected, appropriate laboratory and other diagnostic studies should be considered.


Imaging Studies

Mesenteric angiography is the classic criterion standard diagnostic study. Because the vessels emerge from the anterior wall of the aorta, the ostia are visualized only on a lateral view (see the first image below). A prominent meandering mesenteric artery (see the second image below) is another clue.

Lateral aortogram shows abrupt cutoffs at origin o Lateral aortogram shows abrupt cutoffs at origin of visceral vessels and tapered occlusion of distal aorta. Because these vessels originate from anterior surface of the aorta, stenoses and occlusions are not observed clearly on standard anteroposterior views.
Arteriogram illustrates meandering mesenteric arte Arteriogram illustrates meandering mesenteric artery. Appearance of meandering mesenteric artery such as this one supports diagnosis of chronic mesenteric ischemia.

Duplex ultrasonography (US) is emerging as a useful screening modality in this setting. It currently is most useful in cases where the diagnosis is suspected. [11, 12, 4]

Indices that are studied include the following:

  • Peak systolic flow - This is increased if a stenosis is present
  • Normal vasodilatory response in response to eating - This is lost, especially in the superior mesenteric artery (SMA)

Computed tomography (CT) angiography (CTA) of the aorta and mesenteric arteries is considered an alternative to mesenteric angiography by most authorities.

The use of magnetic resonance direct thrombus imaging (MRDTI) to distinguish between old and new thrombus in the abdominal oarta has been described. [13]


Other Tests

Because most of these patients have generalized vascular disease, it is prudent to carry out a cardiovascular evaluation before performing surgery.