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PubMed1989

[Instrumental and phlebography diagnosis of deep venous leg and pelvic vein thrombosis].

Since plethysmography was introduced as the earliest screening method of peripheral veins there was a constant improvement of apparatus and methods. Presently the color-coded Duplex sonography gives results more detailed than any other screening test and is comparable with the accuracy of phlebography. Nevertheless, since the introduction by Mahler of the "climbing pulse rate" as the best known clinical sign of thrombosis a fundamental problem still waits for the solution: diagnosis of the very beginning of thrombosis. Only when the initial symptoms of the disease are correctly interpreted the best suitable diagnostic methods can be carried out stepwise. A wrong interpretation of the patient's complaints still causes serious retardations of the induction of an adequate therapy.

Blood Flow Velocity↗
PubMed1989

[Comparison of radionuclide venography with roentgen phlebography].

The authors evaluated a group of 78 patients where in addition to radionuclide venography (RNV) also X-ray phlebography was used (RTGF) within a time interval of not more than 72 hours. The results of 102 examinations were compared, 276 areas were correlated at six different sites. Agreement was recorded in 249 instances (90%), a false negative finding in 23 (8%) and a false positive finding in 4 (2%). Sensitivity was low in the area of the calf (55%), high in the femoral area, iliac area and in the area of the inferior vena cava (92-100%). The specificity was in all areas, incl. the calf, relatively high (94-100%). The investigation revealed the disadvantages of RNV--a low reliability in the area of the calf, the impossibility to detect small and parietal thrombi, the inability to assess the "activity and age" of the thrombus, the more difficult interpretation in insufficiency of venous perforators, and advantages of RNV--a great reliability at higher parts of the venous system and after administration of radiopharmaceutical preparations (RF) into peripheral veins, the possibility of simultaneous examination of pulmonary perfusion without further administration of RF, a low failure rate of intravenous administration of RF (less than 2%); RF do not irritate the venous endothelium and therefore thrombosis cannot develop; in case of paravenous escape of RF local inflammations do not develop, the radiation load is low, there is a small probability of allergic reactions, the method is non-invasive, it can be frequently repeated and used for the follow-up of treatment.

Female↗
PubMed1985

Diagnostic methods for deep vein thrombosis: venous Doppler examination, phleborheography, iodine-125 fibrinogen uptake, and phlebography.

Since clinical diagnosis of DVT is often inaccurate, it has become accepted that an objective means of diagnosing clot in the deep venous system becomes critically important in the management of these patients. Important to understanding the diagnostic capabilities of any test are the anatomic and physiologic characteristics of the deep venous system. The venous Doppler examination monitors the velocity of blood flowing through a particular vein. Doppler probes in the 5 to 10 mHz range are routinely used. Respiratory variation is a normal finding due to a diminished flow signal during inspiration, followed by a progressive increase in flow signal during expiration. Characteristics of the spontaneous flow signals are the most important part of interpreting the venous Doppler examination. In addition, the response to distal or proximal compression (augmentation) adds important information to the interpretation; however, the response during any augmentation maneuver depends on the rapidity of compression, the force of compression, the quantity of blood in the veins at the time of compression, and the distance between the Doppler probe and the compression point. The literature reports a wide range of sensitivity and specificity for the Doppler examination, but there is uniform agreement and an observable trend that physicians with a large experience and a dedicated interest will obtain much better results than physicians with less experience and less interest. Phleborheography is a six-channel volumetric plethysmographic technique that monitors volume changes in the lower extremities associated with respiration and foot and calf compression. The volumetric tracings obtained are similar to the velocity profiles obtained on the venous Doppler examination. The criteria used in interpreting phleborheographic tracings are respiratory waves and baseline elevation (major criteria), and prominent arterial pulse waves and foot emptying (minor criteria). Previously reported overall sensitivities for detecting DVT are 83 to 93 percent, with sensitivities of detecting proximal vein thrombosis of 92 to 96 percent. Specificities have been reported to be 87 to 97 percent. In a prospective analysis of 126 extremities with phleborheography and phlebography carried out within the same 24 hour period at Temple University Hospital, we found an overall sensitivity of 79 percent (51 of 65 patients); however, the sensitivity for proximal vein thrombosis was 91 percent (49 of 54 patients).(ABSTRACT TRUNCATED AT 400 WORDS)

Fibrinogen↗
PubMed1986

[Doppler sonography and phlebography in the detection of hemodynamically different varicocele types].

Using the bidirectional doppler sonography to evaluate patients with varicocele two haemodynamically different types of varicoceles, pressure-type and shunt-type, can be determined. By means of retrograde phlebography of the internal spermatic vein (testicular vein) in 44 patients with varicocele the pathophysiologic-anatomic equivalent of these two types could be demonstrated. Shunting veins are the cremasteric vein and deferential vein. The two types of varicoceles have a different effect on male fertility.

Hemodynamics↗
PubMed1988

[Study of the veins of the foot by counter-current phlebography].

83 CF phlebographies of the foot veins were carried out in varicose vein sufferers of both sexes in order to better understand the return venous circulation of the foot in detail, its abnormalities, and also to attempt to explain edema of the foot suffered by many varicose vein patients to varying degrees of severity after saphenous stripping. Films were obtained by direct needle puncture at different sites on the fore-foot, after a tourniquet was placed around the ankle. The route taken by the contrast medium injected was followed on a fluoroscop screen and photographed. Images obtained were classified under 4 headings: 1) slight, 2) moderate, 3) loaded and 4) overloaded opacification. In normal or slightly pathological cases (group 1 and 2), contrast medium was evacuated via a route ranging from level 1 (superficial) to level 3 (deep), this being the "usual evacuation circuit." In frankly pathological cases (groups 3 and 4), a "subsidiary evacuation circuit" may develop. It is also possible that after a degree of stagnation (by obstruction of the main veins of the foot) the contrast medium is very slowly evacuated by a number of small collateral veins. Edema of the foot as seen in some varicose vein patients as well as that which occurs post-operatively in the majority of patients undergoing varicose vein surgery is felt to be more often due to valve incompetence and to hypotonicity of the venous walls rather than to thrombosis of a deep vein of the foot.

Countercurrent Distribution↗
PubMed1988

[Venous diseases of the lower extremities--methods and results of phlebography of the lower extremity--the superficial and deep systems].

The vena saphena magna is the most important arterial vascular substitute in today's vascular surgery. That is why modern varicose vein surgery is performed very carefully and cautiously with an aim to preserve the vessels as much as possible. This can be done only if the radiologist visualises both the healthy and the diseased superficial and deep venous systems as completely and a easily appreciable as possible when diagnosing varicosis. It is not enough to merely produce contrast images of the deep venous system when attempting to clarify varicosis via phlebography. The conditions obtaining at the points where the great saphenous vein and the small saphenous vein open into the femoral and popliteal veins, respectively, must be clearly visible. The maximum possible number of insufficient venae perforantes must be shown and the side branches of the great saphenous vein that have undergone varicose changes, must be visualised. It goes without saying that the deep venous system must be shown in a manner that it can be safely assessed. An extended thrombosis of the deep veins of the leg and pelvis does not present any diagnostic pitfalls when assessing the phlebogram. On the other hand, a beginning deep leg thrombosis is easily overlooked. Phlebographically it is quite difficult to clarify a relapsing thrombosis. This requires detailed knowledge of the patterns of signs in deep leg vein thrombosis.

Humans↗
PubMed1988

[Importance of lateral inspection of the scrotum and value of intraoperative spermatic phlebography in varicocele].

Varicocele appearing on the posterior surface of the scrotum is apt to be overlooked in a routine physical examination. Lateral inspection of the scrotum is important to detect a varicocele of this type. Intraoperative spermatic phlebography on high ligation for varicocele was valuable in confirming the ligation of a single vein or in visualizing the vessel(s) left unligated.

Humans↗
PubMedDate not supplied

[Dynamic selective phlebography of veins in the calf].

The authors present dynamic tests during phlebography, with which try to identify precisely the three layers of the venous circulation of the calf, consisting of the small saphenous vein, the gastrocnemius veins and the soleus veins. Mimicking the phases of walk during these manoeuvres, leads to a simultaneous morphological and functional study of the venous return. The result of these tests leads always to a specific therapeutic attitude.

Humans↗
PubMed1987

[Analysis of errors in imaging diagnosis of varicocele. Duplex sonography, plate thermography and phlebography].

Comparative investigations were done by duplex sonography, thermography and phlebography in 142 patients with 158 varicoceles. Verification of clinical varicoceles (130/158) was performed by duplex sonography in all cases and by thermography in 93%. Measurement errors were due to dorsally located varicoceles near the radix of the penis (3/130) and by small, two-sided varicoceles (6/130). Small subclinical varicoceles (28/158) were detected by real-time sonography in 89%, by Doppler sonography in 64%, and by thermography in 53%. In three patients with normal real-time sonography, subclinical varicoceles were found by Doppler sonography alone. The combination of both sonographic methods is highly sensitive for the detection of subclinical varicoceles and should be done in all cases without therapeutic results.

Humans↗
PubMedDate not supplied

[Dynamic popliteal phlebography].

Since 1984, dynamic popliteal phlebography is an investigative fundamental technique in chronic venous insufficiency of the lower extremities. Our experience includes more than 2,500 examinations. After an anatomical reminder, the technique and methodology of this examination are described. Then its indications are specified: a) in essential varicose veins when a surgical procedure is contemplated in the popliteal fossa: insufficient external saphenous vein, insufficient gemellar veins, etc... b) before repeated surgery for essential varicose veins, c) in the pre-operative evaluation of some post-phlebitic syndromes. Finally, the informations provided by this examination are compared with those provided by clinical examination, Doppler and ultrasonography.

Humans↗
PubMed1987

[Re-permeation of deep venous thrombosis of the lower extremities: comparison between plethysmographic indices and phlebography scores. Preliminary results].

A prospective study, now pursued, has the aim of determining anatomical features (permeability of deep venous trunks and/or development of a collateral venous circulation) related to improvement in plethysmographic indices and comparing these with phlebographic data. Twelve patients have been investigated by occlusive plethysmography and bilateral phlebography of lower limbs on the day of diagnosis, after 10 days of heparin therapy and after 6 months of antivitamin K anticoagulant treatment started on the 11th day. Whereas a progressive improvement in plethysmographic indices and phlebographic scores exists during the course of treatment, no correlation has been observed between plethysmographic indices and degree of phlebographic obstruction. This suggests that the emptying rate indices cannot be considered as an absolute criterion for the decision to discontinue anticoagulant therapy.

Collateral Circulation↗
PubMedDate not supplied

[Study of perforating veins by selective dynamic phlebography].

Selective dynamic phlebography allows an interesting approach to the physiopathology of the gemellus and soleus veins. Moreover it specifies the part played by the posterior perforating veins in the incompetence of the short saphenous vein. Finally it alerts us against untimely surgery of this venous section which is still so unexplored.

Humans↗
PubMedDate not supplied

Value of phlebography for diagnosis and treatment of pulmonary embolism.

The frequency of recurrencies and of post-phlebitic syndrome after PE lead the Authors to perform phlebography of the legs before and after treatment of PE. A venous thrombosis was found in 124 cases out of 144 recent PE proven by angiopneumography. The thrombosis affected the ilio-caval veins 43 times, in 27/103 severe PE cases (24%), in 16/33 moderate PE cases (40%). Patients were treated: by H. in 67 cases; 33 (group I) with moderate PE, (4 (group II) with severe PE; by Streptokinase (SK) 24 times: 5 cases with moderate PE, 19 (group III) with severe PE; but U.K., high dose (UKf) 19 times; by U.K., moderate dose (UKm) 40 times, 3 cases with moderate PE, 37 cases (group V) with severe PE. After treatment, the mean volume of the venous clot, measured by the Marder's index, decreased in all groups. However, S.K. lysed 7 out of 17 proximal thrombosis, whereas the other treatments were unefficient. Failures were less frequent with S.K. (3/16) than with U.K. f (11/15), U.K.m (12/28) and H. (29/65). Recurrency was noticed 8 times: in 7 cases, it was seen in patients affected with proximal V.T. and not treated by I.V.C. interruption. Such facts warrant the systematic search for V.T. when PE is suspected. They justify the use of thrombolytic drugs not only for severe PE, but also for moderate PE which are associated to a proximal V.T.

Adolescent↗
PubMedDate not supplied

Descending phlebography: a comparison of three methods and an assessment of the normal range of deep vein reflux.

Twenty-three legs in 13 patients without evidence of deep vein disease have been examined by descending phlebography using 3 techniques: with the patient semi-erect with no Valsalva manoeuvre with the patient semi-erect with a controlled Valsalva manoeuvre and with the patient supine with a standard Valsalva manoeuvre. It is concluded that the examination performed with the patient supine, using a standard Valsalva manoeuvre, is the most convenient and easiest to interpret of the variation. It is also suggested that deep vein reflux up to Grade 2 is within the normal range.

Adult↗