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PubMed1986

[Role of phlebography in the diagnosis of deep venous thromboses of the legs].

Phlebography makes the diagnosis of lower limbs venous thrombosis possible, and points out as well both site and extension. The technique used is the "free flow" technique which is modified so as to visualize the iliac veins as well as inferior vena cava. The presence of lacunar image or cupula-shaped interruption demonstrates a recent thrombosis above all if associated with venous dilatation; absence of a main venous trunk and collateral circulation do demonstrate a previous thrombosis. Phlebography fails to explore easily some veins, especially pelvic and deep femoral veins, as well as to determine the clot initial appearance. Non-invasive methods, such as labelled fibrinogen, Doppler ultrasonography and rheoplethysmography are less sensitive and specific; only Doppler ultrasonography associated with ultrasound can supply quite good results. Despite such efficient methods, especially ultrasound combined with Doppler ultrasonography, phlebography appears as the main examination in the patients presenting with various thrombosis or pulmonary embolism.

Humans↗
PubMed1986

Congenital aplasia of the deep veins of lower extremities in children: the role of ascending functional phlebography.

Eighty-two children with vascular diseases underwent phlebography. Congenital aplasia of the deep venous system of the lower extremities was diagnosed in 10 children. With ascending functional phlebography, three anatomic variations with different degrees of venous dysfunction were defined: aplasia of the femoral vein with collateral drainage into the common femoral vein, aplasia of the femoral vein with drainage into the internal iliac vein, and total aplasia with drainage into the axillary vein. The phlebographic findings correlated with the symptoms. Patients with type a aplasia had no clinical and radiologic signs of venous insufficiency. Patients with types b and c aplasia had severe venous insufficiency that necessitated supportive treatment. Palliative surgical procedures such as hemorrhoidectomy, clitoridectomy, and excision of bleeding vascular nevi were performed. Ligation or excision of the dilated superficial veins (usually the main channels for venous drainage from the extremity) is absolutely contraindicated. Ascending functional phlebography is therefore essential for correct diagnosis and planning of future therapy.

Adolescent↗
PubMedDate not supplied

[Irradiation of the patient and its costs in the usual diagnostic procedures for disk hernia. Radiculography, spinal phlebography and tomodensitometry].

Three methods are currently employed for the diagnosis of sciatica due to disc lesions: radiculography, spinal phlebography, and computed tomography. Though their indications vary according to the author, it seemed worthwhile to compare radiation delivered by each of them, because of the often young age of the patients. Dosimetric studies using a Rando Phantom enabled calculation of doses to the skin, spinal cord, and gonads. Results indicated that low doses were delivered by the scanner, relatively high doses by spinal phlebography, and intermediate doses by radiculography. These findings suggest that the initial examination preoperatively in cases of simple sciatica due to herniated disc should be a CT scan whenever possible. Phlebography, on the contrary, and particularly in young women, should be used only exceptionally, as a result of the high doses delivered to the ovaries even during technically simple explorations.

Adult↗
PubMed1980

Bacteriology and phlebography in catheterization for parenteral nutrition. A prospective study.

A total of 42 central venous catheterizations in 32 patients were subjected to a prospective study with respect to bacteriologic and thrombotic complications. Growth of bacteria was found in blood cultures in 3 cases (7%) and in cultures from catheter tips in 15 cases (36%). In 25 cases (59%) phlebography revealed partial or complete thrombosis of the central vein. In 7 cases phlebography could not be performed because of blockage of the catheter (5 cases) or thrombophlebitis (2 cases). There was no relationship between bacteriologic and thrombotic complications. The frequency of bacteraemia is in agreement with earlier observations whereas the frequency of catheter-related thrombosis is much higher. This might be due to the fact that phlebography was performed at the time of catheter removal. The presence of catheter-related thrombosis is potentially hazardous as a source of microembolism. Prophylactic anticoagulant therapy in long-term catheterizations for parenteral nutrition is therefore suggested.

Adolescent↗
PubMed1993

[Role of phlebography in the study of recurrent leg varices].

In the last four years, 668 phlebographies of the lower limbs were performed in patients affected with varices. Recurrences were detected in 239 patients. Different phlebographic approaches were used, including ascending phlebography of the popliteal and femoral veins and varicography. Specific indications to different techniques are discussed and possible causes of recurrence are analyzed. In patients with recurrent varices, atypical venous drains were often observed, whose involvement could not be detected by either clinical examination or noninvasive instrumental evaluation. Therefore, phlebography represents a reliable and sensitive technique to recognize recurrent varices.

Adult↗
PubMed1997

A prospective follow-up study of acute deep venous thrombosis using colour duplex ultrasound, phlebography and venous occlusion plethysmography.

OBJECTIVE: To study the extent of deep venous thrombosis (DVT) and thrombus regression over time and to compare the results obtained with different diagnostic techniques. EXPERIMENTAL DESIGN: A prospective follow-up study with repeated examinations during a 6-month period. SETTING: Patients studied at clinical vascular laboratories. PATIENTS: Forty patients hospitalised for acute DVT. Thirty-six of these completed the follow-up period. MEASURES: The diagnosis of DVT was confirmed with phlebographic and/or ultrasonographic techniques. The patient were then re-examined with colour duplex ultrasound and venous occlusion plethysmography after one week, 3 months and 6 months and with phlebography after 1 week and 6 months. The extent of DVT and number of occluded segments were determined with phlebographic and ultrasonographic techniques. Venous occlusion plethysmography was used to evaluate the functional degree of outflow obstruction. RESULTS: Colour duplex scanning at 3 months' and 6 months' follow-up showed that 55% and 74% of initially occlusive thrombi, respectively, were recanalized, with thrombus resolution occurring faster and more completely in those initially limited to popliteal and/or calf level. Discrepancies between phlebography and duplex scanning were found in 6% (26/441) of venous segments investigated by both methods, primarily concerning flow in the veins below the knee. CONCLUSIONS: In comparison with phlebography, colour duplex scanning is an accurate method for evaluation and follow-up of patients with DVT. The non-invasive nature of colour duplex scanning makes this method extremely suitable for repeated studies and thus a potentially very valuable tool for both clinical and research studies of circulatory changes involved in acute and chronic DVT.

Adult↗
PubMed1976

[Phlebography of the lower limb (author's transl)].

Description of the techniques of ascending phlebography and retrograde pressure phlebography of the leg and of means of showing insufficient perforating veins with selective percutaneous or intra-operative injection of contrast-media. Misinterpretation of the deep veins owing to muscular contraction for insufficiently continuous filling is explained. Phlebographic diagnosis of recent phlebothromboses, taking into accout isotope diagnosis, is particularly important for the recognition of post-traumatic so-called masked thromboses. The effectiveness of phlebography for the clarification of neurosegmental angiomatoses is discussed.

Acute Disease↗
PubMedDate not supplied

[The effect of renal arterio- and phlebography on the function of the renin-angiotensin and hypophyseal-adrenal systems].

Based on the analysis of a RX-ray study and a selective blood test for the activity of the plasma renin, aldesterone, hydrocortisone and adrenocorticotropic hormone (ACTH) in 57 patients with arterial hypertension--14 persons without renal failure, 14 ones regularly treated by hemodialysis, 29 patients with left orthostatic varicocele--the authors demonstrated the impact of the renal arterio- and phlebography on the hormone levels studied. Arteriography resulted in an increase in the absolute value of the renal vein renin mean 2.1-fold, aldosterone, 3.3-fold and hydrocortisone, 1.7-fold. A 2.2-fold increase in the renin activity and a 2.6-fold increase in the levels of aldosterone and hydrocortisone noted in all the patients were the result of retrograde renal phlebography. No correlations were established between the changes in hormone levels and the central mechanism of the secretion regulation (ACTH). Radiopaque investigations of the patients with arterial hypertension gave 22 per cent of false positive results with regard to the site of renin secretion and 18 per cent of those with regard to the participation of the studied kidney in renin secretion. The authors supposed a possible regulation of adrenal mineralocorticoid performance by a retrograde blood flow appeared through the adrenal central veins that was induced by phlebography--related elevation of blood pressure in the renal vein.

Adult↗
PubMed1984

Deep vein thrombosis detection by 99mTc-plasmin test and phlebography.

During a 2-year period the diagnostic value of 99mTc-labelled-plasmin test was evaluated in 63 patients admitted with clinical signs of deep vein thrombosis (DVT). In comparison with a conventional phlebography the diagnostic sensitivity and specificity of the plasmin test was 0.97 and 0.55, respectively. The predictive value in positive cases was 0.79 and in negative 0.92. The sensitivity was highest for thrombosis in the calf and popliteal regions, while the specificity was higher for thrombosis in the femoral veins. It is concluded that the 99mTc-labelled-plasmin test is suitable for DVT-screening in groups of high-risk patients and is simple and rapid. In positive cases the DVT diagnosis must be verified by phlebography.

Adolescent↗
PubMed1980

Isotope phlebography in the study of lower extremity venous thrombosis.

Isotope phlebography is performed using 99mTc as pertecnetate, macroaggregates of albumin (MAA) or microspheres of albumin (MISA). The isotope is injected at a dose of 6-10 mCi into the dorsal foot veins. The area studied begins at the knee and is followed successively by the groin, the iliac area and the region of the IVC. A pulmonary scan is performed when MAA or MISA are used. Our method has proven to be reliable in showing 1) thrombosis of the veins of the groin and iliac area, which appear as a 'non visualisation' of the venous tract, 2) delayed transit time of the isotope, 3) visualisation of the superficial circulation (changes and irrgularities). The association of istope phlebography with pulmonary scan is useful for evaluating the femoral-iliac and the vena caval system and for detecting the presence of pulmonary embolism.

Acute Disease↗
PubMed1986

[Phlebography of the femoral head following femoral neck fracture].

The incidence of avascular necrosis (AVN) of the head of the femur after transcervical fracture is 30-60%, depending on the diagnostic methods used. A poor outcome in AVN is not inevitable, since early diagnosis and treatment with prolonged non-weightbearing can produce satisfactory revascularisation without deformity. Nineteen patients with fractures of the femoral neck treated with internal fixation were assessed after operation by per-osseous phlebography. Weightbearing was allowed, irrespective of the state of union of the fracture, only if this test was positive. Of 13 patients who were allowed to bear weight after consolidation of the fracture, only one developed avascular necrosis. A further six patients were treated by non-weightbearing for up to eight months. Only one, in whom the fracture did not unite, developed avascular necrosis. The average time to union was 3.2 months, and the time to weightbearing was 4.1 months. This small difference, taking into account the low incidence of AVN (2 out of 19 or 10.5%, has led us to suggest a fresh approach to fractures of the femur neck in which the indications for immediate arthroplasty are restricted if the patient can tolerate prolonged non-weightbearing. Revascularisation may be assessed with phlebography and weightbearing allowed when this becomes positive. This approach should diminish the incidence of advanced AVN of the femoral head, and widen the indications for internal fixation.

Female↗
PubMed1979

Selective mesenteric phlebography in patients with carcinoid tumors.

Seventeen patients were investigated to localize carcinoid tumor growth in the small intestine and liver. Portography, selective phlebography of the intestinal veins, arteriography, and hormone assay (Serotonin, substance P) after simultaneous catheterization of the celiac artery and portal and caval veins were performed. Most of the patients have been operated on and findings at surgery have been compared with the preoperative localization methods. In 3 cases with small bowel carcinoids and typical fibroplastic changes of the mesentery, phlebography as well as arteriography demonstrated well the degree of mesenteric involvement. None of the methods demonstrated the primary tumors. Arteriography was superior in demonstration of liver metastasis. The hormone assay was a useful complement to angiographic techniques in the diagnosis and localization of tumor growth.

Adult↗
PubMed1978

Impedance plethysmography: its limitations as a substitute for phlebography.

Impedance plethysmography (IPG) was used to study 132 legs: 100 in normal volunteers not subjected to radiocontrast phlebography, seven in patients whose limbs were phlebographically normal, and 25 proven by phlebography to have deep venous thrombosis (DVT). There were no false positive IPG results when a maximum venous outflow of 0.2% was the discriminant. However, in the 25 legs with thrombosis in calf, popliteal, femoral, and iliac veins, clots were not detected by IPG in 44--51% of legs, depending upon the discriminant. These results, which are in agreement with data reported elsewhere, indicate that it is reasonable to use the IPG method as the sole diagnostic maneuver when the test result is clearly abnormal, but that if the result is not abnormal, a radiocontrast phlebogram is necessary.

Adult↗
PubMed1981

Dorsolumbosacral phlebography.

Two variations on the currently most commonly used technical method for phlebography are described. The first variation involves an original method for visualizing the dorsolumbosacral epidural plexus via the retrograde route from the azygos vein. If necessary this can be associated with catheterization and simultaneous injection into an ascending lumbar vein or into a lateral sacral vein. This method permits exploration from T7 to S1 and provides phlebograms of excellent quality, owing to the reduction in the flow caused by countercurrent injection. The second variation involves visualizing the epidural venous plexus by means of double percutaneous transfemoral catheterization of the hypogastric veins, using balloon catheters. This method is performed easily and rapidly. Preferential flow is obtained via the epidural plexus, and there is less diversion of the contrast medium through anastomoses and less filling of the vena cava. The specific indications for these methods are described. The availability of alternative methods beyond the traditional one renders epidural phlebography more reliable and more manageable, and it ensures certainty of diagnosis.

Azygos Vein↗
PubMed1979

Renal phlebography in diagnosis of poorly vascularized renal malignancies.

Eight cases are presented to demonstrate the value and limitations of renal phlebography in the diagnosis of poorly vascularized renal malignancies. Because of the easier compressibility of the thinner venous channels, malignant tumors may cause more pronounced phlebographic changes than seen in corresponding arteriographic studies. Changes include venous compression and amputation, tumor thrombus, and venous neovascularity. It is believed that the supplementary use of renal phlebography at the same time arteriography is being accomplished may increase the chances of preoperatively diagnosing such hypovascular renal malignancies as papillary-tubular adenocarcinomas, metastatic and necrotic malignancies, and invasive transitional cell carcinomas.

Adenocarcinoma↗
PubMed1978

Local complications of ascending phlebography.

In order to estimate the rate of local complications of phlebography we studied a one-year series of 477 patients. Half of the patients were examined with a comparatively highly concentrated contrast medium and half with a more diluted one. Eight patients had local complications, verified by biopsy and/or thermography and plethysmography. One had a deep vein thrombosis, five had a superficial thrombosis and two had a skin necrosis. There were more complications after the use of the more concentrated medium, six against two. The frequency of clinically significant complications to phlebography is rather low, but high enough to warrant attention to the risks of the method. The concentration of the contrast medium should be as low as possible, and the time that the vessels are exposed to the chemical trauma as short as possible. A hypothesis is brought forward that skin necrosis with slow healing could be secondary to arterial thrombosis caused by extravasal contrast injection.

Aged↗
PubMed1982

Phlebography in the salage of dialysis fistulae.

Provision of long-term satisfactory vascular access for haemodialysis is an increasing problem. The functional life of an arteriovenous fistula can be greatly extended by an active salvage policy to which radiology makes an invaluable contribution. Forty-seven consecutive patients with vascular access problems were studied, 11 undergoing forearm phlebography and 36 phlebography of a malfunctioning fistula. Of the 11 patients with forearm phlebograms, only one patient had a fistula constructed that was not used for dialysis, despite demonstration of a patent forearm venous system; and in three patients operation was avoided after demonstration of inadequate veins. Only three of the 36 fistulograms failed to give useful information, whereas in seven patients operation was avoided by demonstration of a normal fistulogram.

Arteriovenous Shunt, Surgical↗
PubMed1996

Iodixanol in leg phlebography: a randomized, double-blind parallel group phase III trial comparing iodixanol to ioxaglate.

PURPOSE: To evaluate the safety and efficacy of iodixanol (Visipaque) in phlebography in order to obtain experience from the use of this contrast medium in this i.v. indication. PATIENTS AND METHODS: Phlebography was performed in 150 patients, as a comparative prospective, double-blind, randomized parallel group study comparing iodixanol 270 mgI/ml with ioxaglate 320 mgI/ml. The tolerability was assessed from occurrence of discomfort, adverse events up to 30 min following injection and late adverse events. Efficacy was assessed by recording the diagnostic information on each venous segment. Statistical analysis was performed using the Cochran-Mantel-Haenszel test in order to correct for a possible centre effect. RESULTS: Frequency of patients reporting discomfort (P=0.002) or adverse events (P<0.001) was statistically significantly lower after the injection of iodixanol than after ioxaglate. There was no statistical difference regarding late adverse events and diagnostic information. CONCLUSION: Iodixanol 270 mgI/ml yielded the same diagnostic information as ioxaglate 320 mgI/ml and was associated with fewer patients reporting adverse events and discomfort.

Adult↗