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Andy I would include data fields for repeating the PSVs of celiac trunk with the patient upright if MALC is indicated by supine results. You should see a normalization of the velocities in the upright position. If so, it rules out a fixed stenosis. Perhaps a check box to indicate abnormal (fish hook) geometry of the celiac. It’s highly controversial but some feel that compression of the nerve plexus may have as much or more to do with symptoms as the artery. Giving somebody a heads up about the atypical bend may give somebody an “aha” moment about symptoms. The MALC patients are often at wits end by the time they get kicked around as far as a vascular lab.
Noting direction of flow of the hepatic may be useful. Retrograde hepatic artery flow correlates highly with CA occlusion or tight stenosis (I can give you a reference).
Include one of the central veins (recommend SMV at least) so that you can optimize your billing codes. As long as you do your complete documented mesenteric exam protocol you should be good to bill 93975.

Steve Knight | Assistant Technical Director
Vascular Ultrasound Core Lab | VasCore Training and Education Center
Massachusetts General Hospital
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From: UVM Flownet <[log in to unmask]> on behalf of Andrew Bebry <[log in to unmask]>
Reply-To: UVM Flownet <[log in to unmask]>
Date: Friday, May 25, 2018 at 9:10 AM
To: "[log in to unmask]" <[log in to unmask]>
Subject: Mesenteric Template


        External Email - Use Caution
Good morning Flownetters:
I would like to 'update' our Mesenteric template where we enter our findings after doing one of these studies.  Would you please share your protocol/template for this study.  It typically includes velocity data for aortic velocity near the SMA/renal, SMA, IMA, celiac axis, splenic, and common hepatic.  Also inhal/exhalation for arcuate ligament compression if indicated.  What else do we need?
Thanks.
Andy Bebry, RVT
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