[Pelvic phlebography by the ischiatic transosseous route].
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In Sweden, there is a widespread use of ascending venography for the diagnosis of deep vein thrombosis of the lower extremities (LEDVT) instead of ultrasonography. The main reason for this is the inferiority of US in diagnosing LEDVT in the calf veins. In order to indirectly estimate the magnitude of this inadequacy, we reviewed all of the cases of attempts to perform venograms at our center during a four-month period. The results showed that only 4-5 per cent of requested and successful venograms were able to show signs of LEDVT in the calf veins (distal LEDVT). With regards to these results and a recent report by SBU (Swedish Council on Technology Assessment in Health Care), we believe that US with compression technique and Doppler should be considered as a replacement for venography of the lower extremities as the first line of diagnostic imaging modality.
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Transumbilical and percutaneous transhepatic catheterization is performed of pancreatic veins. The normal phlebographic anatomy is reported together with the findings in patients with carcinoma of the pancreas. Selective catheterization of pancreatic veins with hormone essay for tumor localization is performed in two patients with islet cell tumor of the pancreas. The authors suggest this to be a valuable method in the diagnosis of endocrine tumors of the pancreas.
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Pelvic veins opacification is very helpful in the diagnosis of vascular pelvic pain. First applied to intrauterine vascularisation and hypoplasia research, hysterophlebography allow the venous side of stasis to be obvious. 1) Normally, a fine intra-parietal network draining in intrauterine peripheric vein (arcuate network) is patterned by the contrast medium. For that 4 vessels roots are leaving: 2 lumbo-ovarian pedicles joining uterine venous side und tubal veins and extending over lumbo-ovarian pedicle; 2 uterine pedicles resulting from 2 uterine veins and receiving vesical veins located in the base of broad ligament. Contrast medium empties very quickly and almost the whole uterus emptying is lasting less than 10 seconds. 2) From a pathological point of view: a) in stasis, intrauterine veins pattern features are: intra-parenchymatous pictures of dilated venous network, local alterations pictures often secondary to thrombosis (9/10 on the left side) with intra-parenchymatous stasis and oblique anastomatic main vessels characterizing uterine veins thrombosis, more than 20 seconds emptying delay. Hysterographic and phlebographic times take advantage to be paired by visualizing mucous lesions (hypoplasia and polyp. endocervical and corporeal) in intra-parenchymatous stasis phenomena. b) Extrauterine stasis signs are characterized by preferentially right pedicles dilatation. Standing in upright position enhances stasis (proclive radiographies at 70 degrees). Dilatation is particularly located at the base of the broad ligament and gives to uterine veins with wide smeets a flexuous feature with wide contrasted clusters. Hence here emptying is slow and belayed.