Sonographers should follow a standard imaging protocol. A complete evaluation includes B-mode imaging, spectral Doppler analysis and color Doppler imaging of all accessible portions of the mesenteric arteries.

Throughout each examination, the sonographer or examiner should:

• Observe sonographic characteristics of normal and abnormal tissues, structures, and blood flow, allowing necessary adjustments to optimize exam quality.
• Assess and monitor the patient’s physical and mental status, allowing modifications to the procedure plan according to the patient’s clinical status.
• Analyze sonographic findings to ensure that sufficient data is provided to the physician to direct patient management and render a final diagnosis.
• Accurately annotate B-mode, color and spectral Doppler images.

Abdominal exams can require various acoustic windows and patient positions to optimize the data available from the patient. These vary from patient to patient depending upon anatomy, body habitus, prior surgery, and the presence and location of bowel gas.

B-mode and/or color Doppler images of the following vessels should be obtained:

• Abdominal aorta
• Celiac artery
• Splenic and hepatic artery (when indicated)
• Superior mesenteric artery at origin and proximal artery
• Inferior mesenteric artery

Spectral Doppler waveforms are obtained, with an appropriate angle of insonation (60 degrees or less), to assess the following vessels:

• Adjacent aorta to celiac or superior mesenteric artery
• Celiac artery origin
• Hepatic artery
• Splenic artery
• Superior mesenteric artery (origin, proximal, mid, and distal)
• Inferior mesenteric artery (origin and proximal vessel)
• Document patency of superior mesenteric vein and inferior vena cava

The presence of a prominent inferior mesenteric artery may indicate a significant compromise of the celiac axis and/or superior mesenteric artery. The common hepatic artery should be evaluated for patency and flow direction in cases of suspected celiac artery occlusion.

If resting velocities in the celiac artery are elevated and median arcuate ligament compression is suspected, instruct the patient to take in a large deep breath and hold it while sampling the arterial velocities, again. If arterial velocities remain elevated and/or turbulent, repeat velocity measurements with the patient sitting upright. Normalization of the velocities with either inspiration or upright position changes confirms arcuate ligament compression.