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[Effect of X-ray contrast medium on peripheral circulation, arterial blood flow and venous capacity in the lower extremities during phlebography (author's transl)].

The influence of contrast medium (20 ml Meglumine Diatrizoate 65%; Angiografin) on peripheral circulation was studied after injection into the vena saphena magna in 12 patients (mean age 40.5 years) with markedly varicose veins. Pneumatic segment-plethysmography and "mercury-in-rubber" strain-gauge-plethysmography were used to investigate local and systemic effects of contrast medium on intravascular basic volume and pressure-dependent venous capacity. Heart rate was controlled by Ecg-monitoring, venous blood pressure by means of a Schwarzer pressure transducer, and peripheral blood flow by means of pneumatic segment-plethysmography. In addition peripheral vascular resistance was calculated. Local effect of contrast medium on large veins was a small insignificant increase (2.2%) of venous capacity. However, there was a significant increase of additional 10% after recirculation (2 P less than 0.01). Intravascular basic volume showed a significant increase as well (2 P less than 0.01). In addition the calculated increase of total intravascular volume--represented by intravascular basic volume plus venous capacity--was 16.3% related to an intravenous pressure of 70 mm Hg. According to these findings, 20 ml contrast medium enlarges the blood volume dumping into the legs with postural changes by approximately 270 ml. Arterial inflow increased significantly (2P less than 0.01) by 40% after contrast injection, whereas mean arterial blood pressure decreased simultaneously. Consequently a reduction of peripheral vascular resistance of 32% was calculated. The neglectable local effect of contrast medium on pressure-dependent venous capacity is probably due to the markedly reduced distensibility of varicose veins. In contrast a striking effect of contrast medium is observed after recirculation, which is felt to be due to a general vasodilatation of capillary vessels and pre- and postcapillary resistance vessels.

Adult↗
PubMed1998

[CT-phlebography. A new method for the diagnosis of venous thrombosis of the upper and lower extremities].

UNLABELLED: Spiral CT venography is a new method in vascular imaging, which is an accurate tool for the evaluation of deep venous thrombosis in the evaluation of deep venous thrombosis in the lower and upper extremity. MATERIALS AND METHODS: 102 lower extremities and 12 upper extremities were evaluated for deep vein thrombosis using spiral-CT-venography. The results were compared with findings of ascending venography, color coded duplex sonography and clinical follow up. RESULTS: Spiral CT venography of the lower extremity showed a sensitivity of 100% and a specifity of 96%. The quality of venous opacification with CT venography compared with ascending venography was superior in all venous segments. DISCUSSION: Spiral CT venography is a valuable tool for the detection of deep venous thrombosis. Advantages of the method are the reduction of the amount of contrast material necessary for opacification and the detection of perivascular soft tissue alterations. The application of CT venography is limited due to higher costs and radiation dosage.

Cost-Benefit Analysis↗
PubMed1998

[Magnetic resonance phlebography (MRP) of the abdomen and pelvis].

PURPOSE: To evaluate the image quality of magnetic resonance venography (MRV) of pelvic and abdominal veins. METHODS: A retrospective analysis of all MRV between 1993 and 1996 was conducted. A 2D-FLASH-TOF without breath hold and with arterial presaturation was used. All venous segments have been assessed for the quality of visualisation and an overall image quality was determined. 43% of our patients had malignant disease and phlebothrombosis had already been diagnosed in 64%. RESULTS: 126 examinations and 1696 venous segments were analysed. The overall quality of the examination was good, however one examination was non diagnostic because of motion artefacts. Vessels along the vertical axis were good visualised in over 90%. Most important reasons for insufficient visualisation were breathing, motion and metal artefacts as well as compression and displacement of veins due to tumour disease. CONCLUSIONS: Magnetic resonance venography without breath hold TOF technique is practical and robust for routine clinical applications.

Abdomen↗
PubMed1998

[Ultrafast MRI phlebography of the lungs].

AIM: Improved detection of pulmonary-venous pathologies by imaging the pulmonary veins without arterial overlay. MATERIAL AND METHODS: Sequential 3D imaging of the pulmonary arterial and arteriovenous phase was performed with an ultrafast 3D FLASH sequence successively acquiring eight 3D data sets every 2.9 s within a single breathhold. For an 8 cm thick 3D slab an interpolated spatial resolution of about 1.4 x 1.9 x 3.3 mm could be achieved. Different protocols for contrast media dose and infusion rate were used. For selective visualization of the pulmonary veins, the pulmonary arterial phase was subtracted from a subsequent arteriovenous phase with the highest venous signal. 5 healthy volunteers, 8 patients with history of a cerebrovascular accident (CVA) of unknown etiology an suspected pulmonary-venous thrombosis and 9 patients with compression of the pulmonary vasculature by centrally growing malignancies were evaluated. RESULTS: With higher infusion rate and lower contrast media dose, arteries and veins could be better separated by their enhancement kinetics. In all cases a complete visualization of the main pulmonary veins, segmental and subsegmental veins up to the fourth order of each lung segment was achieved without any overlay of pulmonary arteries. No thrombi of the pulmonary veins were found in patients with CVA. The obstruction of pulmonary arteries and veins due to vessel compression could be selectively visualized. CONCLUSION: Ultrafast multiphase 3D-Gd-MRA is a new reliable method for selective 3D visualization of pulmonary veins.

Adult↗