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[Isotopic phlebography for control of venous surgery of the lower limb].

Isotopic phlebography with microspheres containing 99 mTc aggregated human albumin is a simple and easily reproducible means of controlling the results of venous surgery of the lower limb and ilio-caval confluent. A comparison in 34 cases with the results obtained by conventional contrast phlebography showed close correlation between the two methods. However, since the images are not as sharp as with contrast phlebography, isotopic phlebography cannot be used for planning procedures prior to reconstructive venous surgery and should be reserved to post-operative control.

Female↗
PubMed1978

Dynamic radionuclide phlebography. A clinical study in patients after total hip replacement.

Dynamic radionuclide phlebography was performed in 50 consecutive patients after total hip replacement to evaluate the diagnostic value of the method compared to contrast phlebography. The investigation was limited to the diagnosis of iliofemoral thrombi. A special injection technique was developed and flow curves, mean transit time and distribution of flow were recorded with a scintillation camera interfaced to a digital computer. Three principally different types of flow curves were observed. Mean transit time was of value in differentiating particle flow in the superficial veins from passage through the deep veins. Out of 15 legs with thrombi in the iliofemoral region, the distribution of flow was significantly changed in 12. Deep vein thrombosis in the lower leg did not influence mean transit time or distribution of flow in the iliofemora region. Extensive collateral flow was rare. Ninety per cent of the thrombi were asymptomatic. The method compares favorably with the 125 I fibrinogen method and cuff impedance phlebography, in diagnosing iliofemoral thrombi after total hip replacement.

Hip Joint↗
PubMed1979

Relative efficacy of clinical examination, electromyography, plain film radiography, myelography and lumbar phlebography in the diagnosis of low back pain and sciatica.

The procedures used in the investigation of low back pain and sciatica have been subjected to a double statistical analysis to determine their diagnostic accuracy, since contradictory opinions have been expressed in the literature. It was found that only lumbar phlebography was more accurate than the most simple procedure, the clinical examination. Myelography is more accurate than clinical examination only in making a positive diagnosis. In this case, it equals the reliability of lumbar phlebography, but so does plain film radiography which however leads to a positive diagnosis less constantly. Lumbar phlebography is the most accurate procedure for making a negative diagnosis, mainly by avoiding a false negative conclusion. A comparison is made with the statements in the literature and the complementary use of the different procedures is proposed for the investigation of low back pain and sciatica.

Adolescent↗
PubMed1979

Thrombosis after phlebography: a comparison of two contrast media.

In two studies 267 consecutive patients with suspected leg vein thrombosis were examined by an 125I-fibrinogen uptake test (125I-FUT) and by phlebography. The ionic meglumine calcium metrizoate (Isopaque Cerebral) was used as the phlebographic contrast medium in 161 patients, and the non-ionic metrizamide (Amipaque) was used in 106. In these two groups 47 and 41 patients, respectively, had normal phlebograms as well as an initially normal 125I-FUT. After phlebography 29 (62%) of the patients who had received meglumine metrizoate had a significant rise in fibrinogen uptake, while such a rise was not found in patients examined with metrizamide. Repeat phlebography showed fresh deep-vein thrombosis in seven of the nine patients with increased uptake, indicating a complication rate of 48%. Consequently, we now use metrizamide in leg phlebogrphy; because of its expense a radioisotope test is employed as a screening procedure.

Adolescent↗
PubMed1993

Pneumatic phlebography: a possible new technique for the assessment of recurrent varicose veins.

Initial experience with a new technique, using an inflatable compression device during ascending phlebography, is described. This method is compared with standard varicography in a small series of patients with recurrent varicose veins. In this pilot study, 13 patients had 17 limbs examined by the new method and 14 limbs by varicography. Below knee perforator incompetence was demonstrated directly in all limbs by 'pneumatic phlebography'. Short-saphenous vein and mid-thigh perforator incompetence were also more frequently demonstrated. The two tests are comparable at showing recurrent or persistent connection at the groin (13 limbs, overall). With modifications of the pressure device, pneumatic phlebography may prove to be an important method of assessing recurrent varicose veins.

Adult↗
PubMed1981

Complications of phlebography: a randomised comparison between an ionic and a non-ionic contrast medium.

A high frequency of thrombotic complications of phlebography with conventional ionic contrast media has recently been reported by several writers. A switch to expensive non-ionic media has been recommended. Such a switch would undoubtedly place great restrictions on the use of this valuable procedure. In this prospective study two types of contrast media were compared. Only patients undergoing phlebography prior to operation for varicose veins and with no history of thrombotic disease were included. Post-phlebographic observations were made by microscopy of surgically removed vein specimens and by plethysmography. No significant difference emerged between the two groups of patients as regards thrombotic complications. A disadvantage of ionic media is their higher rate of immediate side-effects, such as pain. These effects, however, are clinically less important than the thrombotic complications, and they can be reduced by good phlebographic technique. In the authors' opinion, phlebography with ionic media remains justifiable, provided that the examination time is short and the dose and concentration of contrast medium are low.

Clinical Trials as Topic↗
PubMed1978

Intraoperative internal spermatic vein phlebography in the subfertile male with varicocele.

Intraoperative internal spermatic vein phlebography was performed in 20 subfertile patients with a varicocele; 10 patients with varicoceles and left-sided indirect inguinal hernias without fertility problems served as controls. Phlebography was carried out during surgery with the patient supine and in a 45 degree anti-Trendelenburg position to stimulate an "erect" posture. In all 25 patients with a varicocele, valvular insufficiency was demonstrated at the renal-spermatic vein junction. When visualized, the position of the left adrenal vein in all instances was medial to or opposite the renal-internal spermatic vein confluence. This observation, reinforced by simultaneous determinations of cortisol levels in the internal spermatic and antecubital veins, practically excluded the validity of the theory of adrenal hormonal suppression of testicular tissues. In 40% of subfertile patients with a varicocele, double internal spermatic veins and reflux to the distended external spermatic (cremasteric) venous plexus were demonstrated. In no instance were such phenomena observed in the control groups. The not-infrequent failure of operative correction of varicocele seems to relate directly to such overlooked pathology. Broad clinical application of operative phlebography, especially in recurrent, persistent, or clinically advanced cases, will detect such anomalies and should reduce significantly the operative failures in the surgical correction of varicocele.

Adult↗
PubMed1995

Colour Doppler ultrasound in diagnosing venous insufficiency. A comparison to descending phlebography.

OBJECTIVE: To evaluate the technique of ultrasound colour Doppler in diagnosing venous valvular incompetence in the lower leg. DESIGN: Prospective clinical study. SETTING: Department of clinical physiology. MATERIALS: 44 patients (56 legs) referred with a clinical diagnosis of deep venous insufficiency. CHIEF OUTCOME MEASURES: Colour Doppler and descending phlebography. MAIN RESULTS: Using phlebography as a "gold standard" the accuracy of the colour Doppler technique varied between 93% and 55% for the different veins. For the superficial and deep femoral veins, the popliteal vein and the long and short saphenous veins the accuracy was between 90% and 70%. The lowest correlation was found for the deep calf veins (55-66% accuracy). CONCLUSIONS: Colour Doppler was found to be a suitable technique for non-invasive investigation of patients with suspected venous insufficiency. Since the colour Doppler technique is non-invasive it is well suited for follow-up studies. Descending phlebography should be reserved as an adjunct technique in patients scheduled for valve reconstructive surgery.

Adolescent↗
PubMed1977

[Occlusion phlebography. Technics and possibilities of use].

The technique and use of occlusion phlebography is described. The method is based on temporary occlusion of blood flow by means of a balloon catheter. Various balloon catheter systems were used and their technical properties were evaluated. The distal veins can be demonstrated by using double lumen catheters, distal and proximal veins by using a catheter with three lumina. Occlusion phlebography is a suitable method for demonstrating hepatic and renal veins; it improves the demonstration of the azygos vein, the suprarenal vein and of visceral pelvic veins, including the iliolumbar veins. It also permits demonstration of the inferior vena cava and parietal veins in the pelvis in separate stages. Occlusion phlebography is the method of choice for the direct demonstration of splenorenal shunts.

Adrenal Glands↗
PubMed2000

Scoring of extensive deep leg vein thrombosis displayed as wide-spread non-filling of contrast on phlebography. A comparison with colour doppler ultrasonography.

PURPOSE: To evaluate whether wide-spread non-filling of contrast in vein segments, displayed on phlebography, is interpreted as deep venous thrombosis (DVT) on colour Doppler ultrasonography (CDU) and if the same score value is obtained. MATERIAL AND METHODS: Twenty consecutive patients were analysed by both phlebography and CDU with a scoring system. RESULTS: One hundred and fifty-one venous segments were initially analysed, but 19 (12.6%) were excluded because their entire extent could not be interpreted by CDU. The total score was 366 (mean 18.3) according to the phlebograms and 298 (mean 14.9) when interpreted by CDU, p=0.0001. The difference was due mainly to the scoring of the anterior tibial vein found to be open on CDU in most cases, and then the thrombotic burden percentage was 84% and 75%, respectively. In 19 of the 20 patients (95%) a DVT was confirmed by CDU. The great saphenous vein, the femoropopliteal vein, and the deep femoral vein, formed the main collateral circulation. CONCLUSION: Wide-spread non-filling of vein segments is due to an extensive DVT in the vast majority of cases. Scoring is possible by both phlebography and CDU and the difference in the results of the scoring is generally of minor importance.

Adult↗
PubMed1979

Noninvasive diagnosis of acute deep vein thrombosis. A comparison between thermography, plethysmography and phlebography.

Fifty-five patients with clinical signs of acute DVT were investigated with thermography, plethysmography and phlebography. A comparison between phlebography and thermography showed a diagnostic agreement of 84%. Thermography was found, however, to have a low reliability for the localization of acute thrombi and was therefore combined with plethysmography in an attempt to obtain better results in this respect. Compared to the invasive phlebography, the noninvasive combination of thermography and plethysmography adequately located acute DVT in 95% of the cases.

Acute Disease↗
PubMed1992

Orbital phlebography: a comparison between cluster headache and other headaches.

Orbital phlebography has previously been found to be pathologic in 8 of 13 patients with episodic cluster headache. To compare the frequency and pattern of the pathologic findings in cluster headache with those in other headache categories, orbital phlebographies were carried out in patients with cluster headache, cervicogenic headache, migraine and tension-type headache (tension headache). The investigations were evaluated independently by two radiologists, one of whom had no knowledge of the diagnoses. The frequencies of pathologic findings were at maximal 2/12 in the cluster headache group, 2/11 in the cervicogenic headache group, 5/12 in the migraine group and 5/15 in the tension-type headache group. The investigators agreed completely in the evaluation of 39/50 phlebograms, with lesser disagreements in 7. In conclusion, the frequency of pathologic findings at orbital phlebography in cluster headache was not higher than in the other diagnostic categories investigated, and the pattern of the pathology was generally the same.

Adult↗
PubMed1978

Complications of ascending phlebography of the leg.

Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg.

Foot Dermatoses↗
PubMed1974

Diagnosis of deep vein thrombosis with 99mTc-streptokinase: a clinical comparison with phlebography.

Nineteen patients with signs of deep vein thrombosis in the legs were investigated with a new technique using (9 9m)Tc-streptokinase. This compound is probably superior to iodine-labelled fibrinogen in detecting established thrombi. The ratio between the activity in the leg with suspected thrombosis and the other leg was calculated. The results were compared with those obtained with phlebography. A pathologically high activity ratio was found in 11 out of 13 patients in whom phlebography showed a thrombus, while the ratio was normal in the remaining six patients who showed no thrombus on phlebography. No negative correlation was found between the activity ratio and the titrated initial dose of streptokinase. The activity ratio as well as diagnosing the presence of a thrombus may also provide a guide for therapy.

Adult↗
PubMed1975

Antegrade spermatic vein phlebography in testicular tumors. A preliminary report.

Phlebography of the spermatic veins may yield valuable information about metastases from testicular tumors. Retrograde venous injection of contrast medium is not always possible but the antegrade approach performed in connection with orchidectomy was successful in all of the 5 cases attempted. If funicular lymphography is performed in connection with the removal of the testis, spermatic vein phlebography may be added with a minimum of additional effort. Whenever orchidectomy for malignant testicular tumor is planned, the possible value of additional diagnostic information from spermatic vein phlebography should be considered.

Adult↗
PubMed1985

Incompetent perforating veins: comparison of varicography and ascending phlebography.

A comparison of the accuracy of incompetent perforating vein visualization using varicography and ascending phlebography is reported. A technique for varicography is described. Sixty-one legs of 50 patients were examined using both methods. In the calf, varicography and ascending phlebography were almost equally accurate, but for the demonstration of incompetent perforating veins of the gastrocnemius muscle and midthigh, varicography was considerably more accurate. It is concluded that varicography is a safe, simple, and accurate method for demonstrating incompetent perforating veins and complements the more conventionally employed ascending phlebography.

Adult↗
PubMed2000

Isolated nonfilling of contrast in deep leg vein segments seen on phlebography, and a comparison with color Doppler ultrasound, to assess the incidence of deep leg vein thrombosis.

Nonfilling of contrast in deep veins on phlebography is claimed to be an indirect sign of deep vein thrombosis (DVT) by some authors but rejected by others. The aim of this study was to prospectively assess, with color Doppler ultrasound (CDU), the occurrence and distribution of DVT in isolated, nonfilling, deep vein segments seen on a phlebogram. One hundred consecutive patients with clinical signs of acute DVT, in whom phlebography displayed nonfilling of the posterior tibial veins and/or the deep calf muscle veins, were examined with CDU on the same occasion. Ultrasound confirmed a DVT in 31 (31%) patients; in another 38 (38%) patients other pathology, without concomitantly detected DVT, such as edema, bleedings, ligament and muscle ruptures, Baker cysts, or superficial thrombophlebitis were found instead; and in the remaining 31 (31%) patients no pathology that could explain the nonfilling was identified. Isolated, nonfilling of the posterior tibial and/or deep muscle veins of the calf found by phlebography may be an indirect sign of DVT but is equally commonly caused by other pathological conditions or arises without any detectable explanation. When the thrombotic burden is to be scored, and to facilitate the establishment of the correct diagnosis, additional CDU is recommended when isolated nonfilling is present.

Adult↗
PubMed1981

Thrombosis after elective phlebography as demonstrated with the 125 I-fibrinogen test.

The 125I fibrinogen test was used in 54 patients before and daily for 4 to 6 days after phlebography, for evaluating the incidence of post-phlebographic thrombosis. The indication for phlebography was in all cases varicose veins with perforators. A significantly increased fibrinogen uptake was found after phlebography in 4/54 patients in the calf, suggesting development of deep venous thrombosis, which, however, could not be confirmed with plethysmography or thermography. None had clinical signs of deep vein thrombosis. The rather low incidence of post-phlebographic thrombosis compared with other series is discussed.

Adult↗