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Popliteal phlebography by puncture of the popliteal vein anables direct opacification to be obtained of the deep venous trunks of the knee and the thigh. This simple technique can be used for precise evaluation of valvular incompetence. Normal and pathological findings after 50 popliteal phlebographies are described.
20% of 450 patients on various programs of hemodialysis underwent phlebography and, in some cases, also arteriography for evaluation and radiographic documentation of their shunt. The most frequent complications thus found were: Congenital variants, thrombosis and stenosis due to fibrotic scanning. Of 224 new shunts placed in 1979, there were 98 with late and only 25 with early complications. In case of complications, data and type of corrective surgery were markedly influenced by phlebography.
We compared the protective value of the above treatments in 227 randomised patients. Investigations in each patient included pulmonary scanning before and after operation, repeated postoperative Doppler and radioactive limb scanning completed by phlebography to confirm positive results. The heparin DHE group and the "physiotherapic" group each totalized 76 patients and the heparin group 75. These comparable groups show that HDHE and heparin prophylaxis are identical; but physiotherapy is perhaps better. Compared with phlebography leg scanning sensitivity is 95%, whilst it's specificity is 99%. Doppler sensitivity is only of 21%, whilst it's specificity is 95%. In conclusion, "physiotherapic" prophylaxis, including Flowtron, is as effective as heparin alone. Doses of heparin may be reduced, without loss of effect, if supplemented by a veinoconstrictive agent as DHE. The low Doppler sensitivity contraindicates its use in asymptomatic DVT detection.
The regular features of the passage of vertical blood reflux from the pelvic veins to the veins of the lower limbs were studied in 65 patients with varicosity by means of retrograde pelvic phlebography (RPP). The following atypical forms of varicosity were found to be absolute indications for RPP: varicosity of the gluteal veins, the veins of the ischiatic and pubic regions, the posterior and medial surface of the upper third of the thigh, and the veins of the genitals. The relative indications are recurrent varicosity with varicose veins in the inguinal region and operative scars preventing puncture of the femoral vein of the limb under study, and the development of various complications in puncture retrograde phlebography which make the examination difficult.
To verify the suspected diagnosis of deep thrombosis in the pelvic and/or the leg veins or to clarify the causes of pulmonary embolism, 84 patients were examined prospectively by color-coded duplex-sonography. The findings in the 103 legs examined were subsequently compared to those of an ascending phlebography. The deep veins from the region of the vena iliaca communis down to the lower leg were visualized, and blood flow, lumen and compressibility were checked. This procedure enabled the identification of totally occluding thrombi as well as partial thrombi with the circumfluent blood. The sensitivity of thrombus identification was 92.9%, the specificity was about 97% in the different segments. The results show that color-coded duplex sonography is a sensitive diagnostic instrument for follow-up in conservative therapy. Also, in postthrombotic changes, fresh clots can be identified for the most part. Color-coded duplex sonography can replace phlebography in most cases, if special attention is paid to regions which are difficult to visualize, such as the pelvic veins, the Hunter's channel and the veins of the lower leg.
1. Tumors with infiltration of the mucosa and submucosa (T1) as muscularis (T2) do not cause anatomical alterations of visceral and parietal pelvic veins, as numerous phlebographies have confirmed. Internal pudendal veins and vessels of the bladder and prostate are involved in all patients with infiltration of bladder tumors into the paravesical tissue or prostate. -- 2. Phlebographic signs for metastatic lymph node involvement in carcinoma of the urinary bladder were observed in 24.5% (T2 in 11.7%, T3 in 33.8%, T4 in 25% of cases). These lesions were absent in tumors which involved the mucosal and submucosal layers (T1) only. -- 3. Alterations of the venous plexus depend on the extent of malignant infiltration in carcinoma of the urinary bladder. These can be recognized in stage II. -- 4. Pelvic phlebography may be helpful in differentiation of carcinomas and adenomas of the prostate.
Iobitridol 250 (Xenetix 250) was compared with iohexol 240 (Omnipaque 240) in phlebography of the lower limbs by means of a multicenter, randomized double-blind trial in 70 patients. No significant difference was demonstrated between the 2 groups in terms of diagnostic efficacy, image quality or clinical safety. Only minor reactions were recorded in the 2 groups, essentially consisting of mild or moderate heat sensations. The only insufficiently informative examinations were not due to the contrast agent. Iobitridol 250 therefore appears to be a well-tolerated contrast medium, suitable for use in phlebography of the lower limbs.
This paper deals with indications and results of phlebographic diagnostics in acute and chronic occlusive processes of the deep veins of the leg and the pelvis. While in former times phlebography was mostly with regard to surgical treatment of varicose veins, today the reconstruction of obliterated deep veins of the lower extremity by by-pass procedures or thrombectomy come to the fore. In the postoperative period is only phlebography that will prove the therapeutical effect exactly.
The performance of funicular lymphography and spermatic vein phlebography during orchiectomy in patients with testicular tumors demonstrates the close proximity of the spermatic vein to the lymph nodes draining the testicles. In the case of metastatic lymph node involvement the spermatic vein phlebography may add supplementary diagnostic information. The examination was proved successful in eight patients with malignant testicular tumors.
Accuracy of phlebography, color duplex sonography and intraoperative findings have been compared in a group of 29 patients operated for postphlebitic syndrome. The highest number of perforating veins was identified during the operation, fewer on phlebography and the fewest on color duplex sonography. However in the upper part of the calf both the latter were found to be inaccurate.
The technique for orbital phlebography is described and the phlebographic anatomy of the orbit and the skull base presented. The possibilities and limitations of phlebography in the diagnosis of different intraorbital and ophthalmoneurological disorders is discussed and illustrated out of personal experiences from 200 cases.
We studied 42 infertile men, who had been surgically treated with modified Palomo method, with intraoperative phlebography of single or multiple testicular veins. We evaluated the efficacy of the performed procedure as well as the presence of other ways of recoil outflow and the connections between the venous vessels of the right testis. In 42 cases surgically treated men with varicocele only in 4 cases the varicocele have been observed additionally on the right side. We are of the opinion that the intraoperative phlebography allows us to performed the proper and the most effective method of the operation of varicocele.
Ninety-two patients with suspected unilateral deep venous thrombosis (DVT) in the lower limb were examined by thermography, plethysmography and phlebography. ROC analysis (Receiver Operating Characteristics) was used to evaluate discrimination thresholds and to compare thermography and plethysmography (four variables) with phlebography. The sensitivity of thermography, 85% (94% for out-patients), was higher than that of plethysmography (58-79%) for the discrimination thresholds chosen. The specificity of thermography was low, 39% (42% for out-patients) or 55%, if obvious relevant clinical findings were included in the evaluation. The specificity of plethysmography was much higher (80-97%). Optimum combination of the four plethysmographic variables showed predictive values of 93-94%, while combination of thermography and plethysmographic variables showed higher predictive values (95-97%), mostly because of a higher sensitivity of thermography for distal DVT. A possible reduction of the number of phlebographic examinations by at least 50% and a cost reduction of 25% could have been obtained without any appreciable loss of diagnostic accuracy. A follow-up study of 112 consecutive patients, examined according to the recommended screening method, showed a reduction of phlebographic examinations by 62%.
With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 groups comprising 22 patients were investigated in whom isolated thrombosis in one of the deep veins segments: lower leg, upper leg, and pelvis was determined by radionuclide phlebography (RNF) and contrast phlebography. Afterwards, all necessary investigations relevant for pulmonary thromboembolism (PTE), including perfusion scintigraphy of the lungs (PSL) were performed. Out of all patients with DTV, 17% were with pulmonary changes confirming PTE. Out of patients with DVT, 59% were with the changes in the upper leg segment, and 66% of patients were with changes in pelvic segment, respectively.
Radionuclide phlebography (RNP) of the lower extremities and pelvis was performed using 99mTc-MAA in 40 patients with pulmonary thromboembolism. Deep venous thrombosis (DVT) was found in all patients, more frequently in the right calf and in the left iliac veins in 20 patients (55%). RNP and contrast phlebography (CP) were performed in 18 patients and confirmed the presence of DVT in all cases. The greatest specificity of RNP was obtained in the left (92.4%) and in the right pelvis (80%). In 12 of 18 patients in whom a cava filter was implanted, specificity of RNP was 100% for the left thigh and 91.7% for other localizations. In establishing indications for cava filter implantation, RNP should be performed prior to CP and bilaterally, but in case of non-indicated CP, RNP findings should be sufficient.
In all 40 patients with pulmonary thromboembolism (PTE) radionuclide phlebography (RNP) detected deep venous thrombosis (DVT), most commonly in the left iliac veins, in 20 (50%). RNP and contrast phlebography (CP) were performed in 18 patients and RNP sensitivity was found in 100% in all localizations of DVT and the largest specificity was obtained in the left side of the pelvis, in 92%. In 12 out of 18 patients cava filter was implanted and BNP specificity in the left upper leg reached 100% and in the right one 89.3%. In establishing indications for cava filter implantation RNP should be performed first so that by detecting embologenous TDV localizations the risk of jatrogenous PTE at cava filter implantation would be avoided or CF, if necessary.
Ultrasound phlebography was used in 67 patients with circulatory failure and 40 normal persons to study the linear parameters of the abdominal veins. The parallelism was revealed between the intensity of circulatory failure and reduction of the changes in the main venous vessels during the respiratory test with the body being in the horizontal and vertical positions. Ultrasound phlebography of the inferior vena cava and liver veins makes it possible to establish circulatory failure in the greater circulation at an early stage. The examination of the portal veins appeared to be of the informative value only at late stages of circulatory failure.
The diagnosis of herniated disks with the use of lumbar epidural phlebography is discussed. Fifty patients were examined. The diagnosis was verified during the operation in 38 of 44 patients. Proper technical performance of the procedure provides the possibility for localizing the herniated disk with high precision, which is very important in surgical management. The relatively simple techniques, the absence of serious complications, and the exactness of the diagnosis provide the grounds for recommending transfemoral lumbar epidural phlebography for wide use.