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[Investigation of the thrombo-embolic disease by simultaneous lung scintigraphy and lower limb gamma-phlebography (author's transl)].

A venous thrombosis in the territory of the inferior vena cava and a possible embolus of the lung can be detected in one single examination by injecting 99 m Tc microagregates into a dorsal blood flow by this method, which associates radionuclide phlebography of the lower limbs and lung scanning, was carried out 140 times in 127 patients and resulted in the detection of 107 cases obliged us to investigate only one limb, gamma-phlebography appears to be a harmless procedure well suited to the study of the thrombo-embolic disease.

Humans↗

Deep vein reflux: an assessment by descending phlebography.

This study of 51 patients aims to define the 'normal' range of reflux in the deep veins and the incidence of pathological reflux in patients with the post-thrombotic syndrome (PTS). 'Normal' limbs, limbs with simple varicose veins and limbs with post-thrombotic syndrome have been studied using a standardized technique for descending phlebography, supine and with a controlled Valsalva. The 'normal' range of reflux has been found to be grade 0-2. The incidence of pathological reflux in patients with proven post-thrombotic damage to the deep veins is 31 per cent.

Humans↗

The potential of vertebral phlebography for the diagnosis of tumours in the posterior cranial fossa.

The diagnostic value of the vertebral phlebogram is emphasized. A practice orientated principle is recommended for the classification of infratentorial veins. A total of 132 phlebograms taken from patients with intratentorial tumours is analyzed for local diagnosis, general diagnosis, venous circulatory disorder, and pathologic veins. An example is given to underline the importance of tomography in vertebral phlebography.

Brain Neoplasms↗

Orbital phlebography in the diagnosis of painful ophthalmoplegia.

Three cases of painful ophthalmoplegia have been described in which symptoms suggesting a tumor of the orbit justified neuroradiological assessment. Phlebography in each case revealed stenosis of the superior ophthalmic vein in its third portion, and non-opicification of the cavernous sinus. Hirtz incidences revealed contralateral cavernous sinus opacification and venous drainage through the coronary sinus. These neuradiological findings helped to differentiate this syndrome from other affections which have similar signs and symptoms.

Adult↗

Techniques in transfemoral lumbar epidural phlebography.

For lumbar epidural phlebography an even distribution of the injected contrast medium over the epidural and intervertebral venous system is of the greatest importance in order to prevent the false positive diagnosis of a lumbar disk lesion due to an artificial filling defect. Various catheter placement techniques and other procedures designed to enhance epidural opacification are compared in this respect. In the author's opinion, selective injection of the contrast medium into an intervertebral vein, when possible, leads to the most reliable epidural filling.

Catheterization↗

[Phlebography in fractures and dislocations of the talus (author's transl)].

Late osteonecrosis and/or osteoarthrosis occurs frequently after dislocation and fracture dislocation of the talus. The cause seems to be a primary vascular lesion additionally to the initial damage of bone and cartilage and subsequent joint incognity. We recommended phlebography 3 to 6 months after injury for the proof or exclusion of a vascular lesion. Our experience with this method has been encouraging.

Adult↗

The diagnostic role of the intraosseous phlebography in the affections of the hip in childhood.

The authors have applied intraosseous phlebography 38 times in 33 children, in order to assess the extent of damage to the femoral head circulation in fractures of the femoral neck and other disorders. Contrast medium was injected mostly into the epiphysis, but eventually into the metaphysis too. Results of these examinations have been important guidelines in the management of the disease, i.e. if the venous drainage of the contrast medium was delayed or absent, or if the contrast medium was congested in the head, the weightbearing had to be releaved until regenerative signs of the femoral head were seen.

Adolescent↗

[The course of postoperative deep vein thrombi as judged by repeated phlebographies].

Phlebography was carried out in a prospective randomised, controlled study during which dextran and small doses of s.c. heparin have been compared in general surgical and urological patients, in 31 persons with proven deep vein thrombois diagnosed with the 125I-fibrinogen test. In 16 out of the 31 patients a second phlebogram coule be performed two weeks later. In this study all thrombi occurred intraoperatively. In 24 of the 31 patients, the appearance of thrombi was multilocular. Independent of the prevention instituted and irrespective of the therapy, the following phenomena could be seen 14 days after the first phlebogram: 9 thrombi retracted, 6 disappeared completely and 1 occluded the vein completely. 2 thrombi disappeared without any therapy whatsoever, the 4 others disappeared in patients receiving heparin and/or coumarin for treatment.

Clinical Trials as Topic↗

[Technical aspects of phlebography in varicosis of the lower limbs (author's transl)].

Ascending phlebography is a safe and reliable method for preinterventional differential diagnosis of primary and secondary venous insufficiency. With the combined use of fluoroscopy and spot filming, the technique yields functional information on the venous valves and communicating veins. It also permits exact localization of peripheral and proximal varicosis and venous aneurysms. In addition, the plevic and inferior vena cava inflow can be evaluated.

Fluoroscopy↗

[Quality assurance in phlebography of the extremities. German Societies for Angiology and Phlebology and Vascular Surgery].

By interdisciplinary cooperation with the German Societies for Angiology, Phlebology and Vascular Surgery, recommendations have been worked out which address the indication of phlebography of the veins of the extremities and which define the quality standards of phlebographic techniques. The specific clinical questions in varicose syndrome acute thrombosis and postthrombotic syndrome have to be answered by employing adequate phlebographic technique, documentation, and description of relevant morphologic and functional findings.

Angiography↗

Assessment of lumbar spinal canal stenosis by magnetic resonance phlebography.

There is evidence to suggest that cauda equina intermittent claudication is caused by local circulatory disturbances in the cauda equina as well as compression of the cauda equina. We evaluated the role of magnetic resonance phlebography (MRP) in identifying circulatory disturbances of the vertebral venous system in patients with lumbar spinal canal stenosis. Extensive filling defects of the anterior internal vertebral venous plexus were evident in patients with lumbar spinal canal stenosis ( n = 53), whereas only milder abnormalities were noted in patients with other lumbar diseases ( n = 16) and none in normal subjects ( n = 13). The extent of the defect on MRP correlated with the time at which intermittent claudication appeared. In patients with lumbar spinal canal stenosis, extensive defects of the internal vertebral venous plexus on MRP were noted in the neutral spine position, but the defect diminished with anterior flexion of the spine. This phenomenon correlated closely with the time at which intermittent claudication appeared. Our results highlight the importance of MRP for assessing the underlying mechanism of cauda equina intermittent claudication in patients with lumbar spinal canal stenosis and suggest that congestive venous ischemia is involved in the development of intermittent claudication in these patients.

Adult↗

The role of intraosseous phlebography in the prognosis of injuries of the talus.

Fracture-dislocations of the talus are often followed by avascular necrosis. In these cases weight bearing must be forbidden in order to prevent collapse of the talus. Experience with intraosseous phlebography in 31 cases and a 2- to 6-year follow-up in 25 of them showed that this is a useful diagnostic procedure in the assessment of the talar blood supply, and an important aid in deciding the necessary period of relief from weight bearing as well as giving a prognosis.

Adult↗

Techniques of phlebography: a review.

Phlebographic techniques for ascending and descending phlebography, and varicography based on personal experience of over 15,000 examinations are described. The indications for their use and their interpretation are discussed.

Contrast Media↗

Vulval phlebography in the pelvic congestion syndrome.

Twelve patients referred to a general surgeon with special interest in varicose veins were found to have vulval varices. All the patients were considered to be suffering from the pelvic congestion syndrome. Their radiological investigation by percutaneous vulval phlebography is described. It is suggested that patients with vulval varices should be examined radiologically by percutaneous vulval vein injection of contrast medium. It is postulated that pelvic vein thrombosis may precipitate the pelvic congestion syndrome. Whereas there is no established treatment of this syndrome, the radiological examination has proved helpful in planning the treatment of these patients.

Adult↗

The accuracy of bolus ascending phlebography in demonstrating the ilio-femoral segment.

The phlebograms of the ilio-femoral segment obtained by a bolus technique in 100 patients were reviewed. The technique of bolus phlebography from bipedal injections is described in detail. In 92% of the phlebograms the ilio-femoral segment was considered to be sufficiently well opacified to exclude thrombus. Follow-up of the patients confirmed the accuracy of the method.

Femoral Vein↗

Thrombotic side-effects of lower-limb phlebography.

In 20 of 61 patients with initially normal phlebograms, uptake of 125I-labelled fibrinogen subsequently increased. In 4 (7%) cases, independent examinations (pulmonary scintigram or a new phlebogram) demonstrated a thromboembolic or thrombotic process. These results suggest that thrombosis and embolism may be caused by phlebography.

Adult↗

[Quality assurance in phlebography of the extremities].

By interdisciplinary cooperation with the German Societies for Radiology, Phlebology and Vascular Surgery, recommendations have been worked out which address the indication of phlebography of the veins of the extremities and which define the quality standards of phlebographic techniques. The specific clinical questions in primary varicose, acute thrombosis and postthrombotic syndrome have to be answered by employing adequate phlebographic technique, documentation, and description of relevant morphologic and functional findings.

Contraindications↗

Intra-medullary pressure and intra-osseous phlebography in paraplegia.

Intra-medullary pressure and intra-osseous phlebography have been studied in the femurs of ten paraplegics. These methods are reliable for studying bone circulation. Results show that there exists an increase of intra-medullary pressure of more than twice the normal value and signs of delayed blood flow as well as a diaphyseal reflux in the bone. The blood gases are also modified (O2 saturation; pO2 and pCO2). These signs indicate that there is a venous stasis. These circulatory disturbances are due to an autonomic nervous system lesion. Furthermore it seems that these vascular modifications below the neurological lesion have an influence on the osteoporosis in paraplegia.

Blood Gas Analysis↗