Phlebography

Definition

Phlebography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot.

Purpose

Phlebography is primarily performed to diagnose deep vein thrombosis—a condition in which clots form in the veins of the leg that can lead to pulmonary embolism in which those clots break off, travel to the lungs and pulmonary artery. Phlebography can also be used to distinguish blood clots from obstructions in the veins, to evaluate congenital vein problems, to assess the function of the deep leg vein valves, and to identify a vein for arterial bypass grafting. Ultrasound has replaced phlebography in many cases; but phlebography is the "gold standard" or the best test by which others are judged, but not used as a standard practice.

Precautions

Phlebography is usually not performed in patients with kidney (renal) problems.

Description

Phlebography, also called venography, ascending contrast phlebography, or contrast phlebography, is an invasive diagnostic test that provides a constant image of leg veins on a fluoroscope screen. Phlebography identifies the location, extent, and degree of attachment of blood clots, and enables the condition of the deep leg veins to be assessed. It is especially useful when there is a strong suspicion of deep vein thrombosis, after noninvasive tests have failed to identify the disease.

Phlebography is the most accurate test for detecting deep vein thrombosis. It is nearly 100% sensitive and specific in making this diagnosis (pulmonary embolism is diagnosed in other ways). Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a condition that can be fatal.

Phlebography is not used often, however, because it is painful, expensive, exposes the patient to a fairly high dose of radiation, and can cause complications. In about 5% of cases, there are technical problems in conducting the test. In addition, the test is less accurate in diagnosing problems below the knee.

Phlebography takes between 30 to 45 minutes and can be done in a physician's office, a laboratory, or a hospital. During the procedure, the patient lies on a tilting xray table. The area where the catheter will be inserted is sometimes shaved, if necessary, and cleaned. Sometimes a local anesthetic is injected to numb the skin at the site of the insertion. A small incision may be required to make a point for insertion. The catheter is inserted and the contrast solution (or dye) is slowly injected. Injection of the dye causes a warm, flushing feeling in the leg that may spread through the body. The contrast solution may also cause slight nausea. About 18% of patients experience discomfort from the contrast solution.

In order to fill the deep venous system with dye, a tight band (tourniquet) may be tied around the ankle or below the knee of the side into which the dye is injected, or the lower extremities may be tilted. The patient is asked to keep the leg still. The doctor also observes the movement of the solution through the vein with a fluoroscope. At the same time, a series of x rays is taken. When the test is finished, fluid is injected to clear the dye from the veins, the catheter is removed, and a bandage is applied over the site of the injection.

Preparation

Fasting or drinking only clear liquids is necessary for four hours before the test, although the test may be done in an emergency even if the patient has eaten. The contrast solution contains iodine, to which some people are allergic. Patients who have allergies or hay fever , or have had a bad reaction to a contrast solution, should tell their doctor.

Aftercare

Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. If there is swelling, redness, pain , or fever, the doctor should be notified. Pain medication may be needed. In most cases, the patient can resume normal activities the next day.

Complications

Phlebography can cause complications such as phlebitis, tissue damage, and the formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the dye. This usually happens within 30 minutes after injection of the dye and requires medical attention.

Results

Normal phlebography results show proper blood flow through the leg veins.

Abnormal phlebography results show well-defined filling defects in veins. Findings include:

• blood clots
• consistent filling defects
• an abrupt end of a test dye column
• major deep veins that are unfilled
• dye flow that is diverted (These results confirm a diagnosis of deep vein thrombosis.)

KEY TERMS

Contrast solution —A liquid dye injected into the body that allows veins to be seen by x rays. Without the dye, the veins could not be seen on x rays.

Deep vein thrombosis —The development or presence of a blood clot in a vein deep within the leg. Deep vein thrombosis can lead to pulmonary embolism.

Invasive —A diagnostic test that invades healthy tissue; in the case of phlebography, through an incision in a healthy vein.

Pulmonary embolism —An obstruction of a blood vessel in the lungs, usually due to a blood clot that blocks a pulmonary artery. Pulmonary embolism can be very serious and in some cases is fatal.

Health care team roles

A phelbography is generally performed in a hospital, or in an outpatient or freestanding facility. A qualified xray lab technician, nurse, or doctor might perform the test, with a radiologist reading or interpreting the results that are presented to the patient either directly, or through the primary care physician. Because the patient will be asked to lie on the x-ray table and a vein is punctured in order for the test to be taken, an attending nurse or other medical assistant in addition to the person performing the test should be present to assist when necessary. A professional will be prepared to handle any possible complication, especially if a patient experiences an allergic reaction to the test medium.

Resources

BOOKS

DeBakey, Michael E., and Antonio M. Gotto, Jr. "Invasive Diagnostic Procedures." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997, 78.

"Phlebography." In Mayo Clinic Practice of Cardiology. 3rd ed. St. Louis: Mosby, 1996, 1840-1841.

Texas Heart Institute. "Diseases of the Peripheral Arteries and Veins." In Texas Heart Institute Heart Owner's Handbook. New York: Wiley & Sons, 1996.

"Venous Imaging." In Diagnostic Nuclear Medicine. 3rd ed., Vol. 1. Baltimore: Williams & Wilkins, 1996, 586-587.

PERIODICALS

Barloon T. J., G. R. Bergus, and J. E. Seabold. "Diagnostic Imaging of Lower Limb Deep Venous Thrombosis." American Family Physician 56 (September 1, 1997): 791-801.

Tapson, Victor F. "Pulmonary Embolism—New Diagnostic Approaches." New England Journal of Medicine 336 (May 15, 1997).

OTHER

"Lower-Limb Venography." Test Universe Website. 11 July 2001. <http://www.testuniverse.com/mdx/MDX-2970.html>.

Springhouse Corporation. "Catching Deep Vein Thrombosis in Time: Diagnostic Tests at a Glance." SpringNet. 2001. 11 July 2001. <http://www.springnet.com/ce/p507bs4.htm>.

Lori DeMilto

Stéphanie Islane Dionne

Phlebography

Definition

Phlebography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot.

Purpose

Phlebography is primarily performed to diagnose deep vein thrombosis—a condition in which clots form in the veins of the leg that can lead to pulmonary embolism in which those clots break off, travel to the lungs and pulmonary artery. Phlebography can also be used to distinguish blood clots from obstructions in the veins, to evaluate congenital vein problems, to assess the function of the deep leg vein valves, and to identify a vein for arterial bypass grafting. Ultrasound has replaced phlebography in many cases; but phlebography is the "gold standard" or the best test by which others are judged, but not used as a standard practice.

Precautions

Phlebography is usually not performed in patients with kidney (renal) problems.

Description

Phlebography, also called venography, ascending contrast phlebography, or contrast phlebography, is an invasive diagnostic test that provides a constant image of leg veins on a fluoroscope screen. Phlebography identifies the location, extent, and degree of attachment of blood clots, and enables the condition of the deep leg veins to be assessed. It is especially useful when there is a strong suspicion of deep vein thrombosis, after noninvasive tests have failed to identify the disease.

Phlebography is the most accurate test for detecting deep vein thrombosis. It is nearly 100% sensitive and specific in making this diagnosis (pulmonary embolism is diagnosed in other ways). Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a condition that can be fatal.

Phlebography is not used often, however, because it is painful, expensive, exposes the patient to a fairly high dose of radiation, and can cause complications. In about 5% of cases, there are technical problems in conducting the test. In addition, the test is less accurate in diagnosing problems below the knee.

Phlebography takes between 30 to 45 minutes and can be done in a physician's office, a laboratory, or a hospital. During the procedure, the patient lies on a tilting x-ray table. The area where the catheter will be inserted is sometimes shaved, if necessary, and cleaned. Sometimes a local anesthetic is injected to numb the skin at the site of the insertion. A small incision may be required to make a point for insertion. The catheter is inserted and the contrast solution (or dye) is slowly injected. Injection of the dye causes a warm, flushing feeling in the leg that may spread through the body. The contrast solution may also cause slight nausea. About 18% of patients experience discomfort from the contrast solution.

In order to fill the deep venous system with dye, a tight band (tourniquet) may be tied around the ankle or below the knee of the side into which the dye is injected, or the lower extremities may be tilted. The patient is asked to keep the leg still. The doctor also observes the movement of the solution through the vein with a fluoroscope. At the same time, a series of x rays is taken. When the test is finished, fluid is injected to clear the dye from the veins, the catheter is removed, and a bandage is applied over the site of the injection.

Preparation

Fasting or drinking only clear liquids is necessary for four hours before the test, although the test may be done in an emergency even if the patient has eaten. The contrast solution contains iodine, to which some people are allergic. Patients who have allergies or hay fever, or have had a bad reaction to a contrast solution, should tell their doctor.

Aftercare

Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. If there is swelling, redness, pain, or fever, the doctor should be notified. Pain medication may be needed. In most cases, the patient can resume normal activities the next day.

Complications

Phlebography can cause complications such as phlebitis, tissue damage, and the formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the dye. This usually happens within 30 minutes after injection of the dye and requires medical attention.

Results

Normal phlebography results show proper blood flow through the leg veins.

Abnormal phlebography results show well-defined filling defects in veins. Findings include:

• blood clots
• consistent filling defects
• an abrupt end of a test dye column
• major deep veins that are unfilled
• dye flow that is diverted (These results confirm a diagnosis of deep vein thrombosis.)

KEY TERMS

Contrast solution— A liquid dye injected into the body that allows veins to be seen by x rays. Without the dye, the veins could not be seen on x rays.

Deep vein thrombosis— The development or presence of a blood clot in a vein deep within the leg. Deep vein thrombosis can lead to pulmonary embolism.

Invasive— A diagnostic test that invades healthy tissue; in the case of phlebography, through an incision in a healthy vein.

Pulmonary embolism— An obstruction of a blood vessel in the lungs, usually due to a blood clot that blocks a pulmonary artery. A pulmonary embolism can be very serious and in some cases is fatal.

Health care team roles

A phelbography is generally performed in a hospital, or in an outpatient or freestanding facility. A qualified x-ray lab technician, nurse, or doctor might perform the test, with a radiologist reading or interpreting the results that are presented to the patient either directly, or through the primary care physician. Because the patient will be asked to lie on the x-ray table and a vein is punctured in order for the test to be taken, an attending nurse or other medical assistant in addition to the person performing the test should be present to assist when necessary. A professional will be prepared to handle any possible complication, especially if a patient experiences an allergic reaction to the test medium.

Resources

BOOKS

DeBakey, Michael E., and Antonio M. Gotto, Jr. "Invasive Diagnostic Procedures." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997, 78.

"Phlebography." In Mayo Clinic Practice of Cardiology, 3rd ed. St. Louis, MO: Mosby, 1996, 1840-1841.

Texas Heart Institute. "Diseases of the Peripheral Arteries and Veins." In Texas Heart Institute Heart Owner's Handbook. New York: Wiley & Sons, 1996.

"Venous Imaging." In Diagnostic Nuclear Medicine, 3rd ed., Vol. 1. Baltimore, MD: Williams & Wilkins, 1996, 586-587.

PERIODICALS

Barloon T. J., G. R. Bergus, and J. E. Seabold. "Diagnostic Imaging of Lower Limb Deep Venous Thrombosis." American Family Physician 56 (September 1, 1997): 791-801.

Tapson, Victor F. "Pulmonary Embolism—New Diagnostic Approaches." New England Journal of Medicine 336 (May 15, 1997).

OTHER

"Lower-Limb Venography." Test Universe Website. 11 July 2001. 〈http://www.testuniverse.com/mdx/MDX-2970.html〉.

Springhouse Corporation. "Catching Deep Vein Thrombosis in Time: Diagnostic Tests at a Glance." SpringNet. 2001. 11 July 2001. 〈http://www.springnet.com/ce/p507bs4.htm〉.

Venography

Definition

Venography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot.

Purpose

Venography is primarily performed to diagnose deep vein thrombosis (a condition that can lead to pulmonary embolism ). It is the standard procedure used to detect this type of disorder. Venography also can be used to distinguish blood clots from obstructions in the veins, to evaluate congenital vein problems, to see how the deep leg vein valves are working, and to identify a vein for arterial bypass grafting.

Precautions

Venography usually is not performed in patients with kidney (renal) problems.

Description

Venography (also called phlebography, ascending contrast phlebography, or contrast venography) is an invasive diagnostic test that provides a constant image of leg veins on a fluoroscope screen. Venography identifies the location, extent, and degree of attachment of the blood clots, and enables the condition of the deep leg veins to be assessed. It is especially useful when there is a strong suspicion of deep vein thrombosis, but non-invasive tests have failed to identify the disease.

Venography is the most accurate test for detecting deep vein thrombosis. It is nearly 100% sensitive and specific in making this diagnosis (pulmonary embolism is diagnosed in other ways). Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a condition that can be fatal.

Venography is not used often, however, because it is painful, expensive, exposes the patient to a fairly high dose of radiation, and can cause complications. In about 5% of cases, there are technical problems in conducting the test. In addition, the test is less accurate in diagnosing problems below the knee. Venography takes between 30-45 minutes and can be done in a physician's office, outpatient center, or a hospital.

In 2003, a report said that computed tomography (CT) scanning could be used to diagnose pulmonary embolism and deep veinous thrombosis in one examination. By combining CT angiography and CT venography, researchers could look for both conditions in one procedure with high-speed CT scanners. The procedure was quick and delivered a reduced radiation dose. However, it has not become accepted as a replacement for traditional venography and is only preferred if the patient is clinically stable and requires immediate diagnosis and treatment.

During the procedure, the patient lies on a tilting x-ray table. The area where the catheter will be inserted will be shaved, if necessary, and cleaned. Sometimes a local anesthetic is injected to numb the skin at the site of the insertion. A small incision may be required to make a point for insertion. The catheter is inserted and the contrast solution (or dye) is slowly injected. Injection of the dye causes a warm, flushing feeling in the leg that may spread through the body. The contrast solution also may cause slight nausea. About 18% of patients experience discomfort from the contrast solution.

In order to fill the deep venous system with dye, a tight band (or tourniquet) may be tied around the ankle of the foot the dye is injected into, or the lower extremities may be tilted. The patient is asked to keep the leg still. The doctor also observes the movement of the solution through the vein with a fluoroscope. At the same time, a series of x rays are taken. When the test is finished, fluid is injected to clear the dye from the veins, the catheter is removed, and a bandage is applied over the site of the injection.

Preparation

Fasting or drinking only clear liquids is necessary for four hours before the test. However, sometimes the test is done in an emergency even if the patient has eaten. The contrast solution contains iodine, to which some people are allergic. Patients who have allergies or hay fever, or have had a bad reaction to a contrast solution, should tell the doctor. A sedative, such as diazepam (Valium), may be prescribed to help the patient relax.

Aftercare

Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. If there is swelling, redness, pain, or fever, the doctor should be notified. Pain medication may be needed. In most cases, the patient can resume normal activities the next day.

Risks

Venography also can cause complications such as phlebitis, tissue damage, and the formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the dye. This usually happens within 30 minutes after injection of the dye and requires medical attention.

Normal results

Normal venography results show proper blood flow through the leg veins.

Abnormal results

Abnormal venography results show well-defined filling defects in veins. Findings include:

• blood clots
• consistent filling defects
• an abrupt end of a test dye column
• major deep veins that are unfilled
• dye flow that is diverted.

KEY TERMS

Contrast solution— A liquid dye injected into the body that allows veins to be seen by x rays. Without the dye, the veins could not be seen on x rays.

Deep vein thrombosis— The development or presence of a blood clot in a vein deep within the leg. Deep vein thrombosis can lead to pulmonary embolism.

Invasive— A diagnostic test that invades healthy tissue; in the case of venography, through an incision in a healthy vein.

Pulmonary embolism— An obstruction of a blood vessel in the lungs, usually due to a blood clot, that blocks a pulmonary artery. Pulmonary embolism can be very serious and in some cases is fatal.

These results confirm a diagnosis of deep vein thrombosis.

Resources

PERIODICALS

Abella, H.A. "CT Dose Techniques Address PE, DVT—Indirect Venography and Collimation Changes Reduce Exposure." Diagnostic Imaging November 1, 2003.

Phlebography

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results

Definition

Phlebography is an x-ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient’s foot.

Purpose

Phlebography is primarily performed to diagnose deep vein thrombosis—a condition in which clots form in the veins of the leg. Pulmonary embolism can occur when those clots break off and travel to the lungs and pulmonary artery. Phlebography can also be used to evaluate congenital vein problems, assess the function of the deep leg vein valves, and identify a vein for arterial bypass grafting. Ultrasound has replaced phlebography in many cases; but phlebography is the “gold standard,” or the best test by which others are judged, even though it is not used routinely.

Description

Phlebograph, (also called venography, ascending contrast phlebography, or contrast phlebography) is an invasive diagnostic test that provides a constant image of leg veins on a fluoroscope screen. Phlebography identifies the location and extent of blood clots, and enables the condition of the deep leg veins to be assessed. It is especially useful when there is a strong suspicion of deep vein thrombosis, after noninvasive tests have failed to identify the disease.

Phlebography is the most accurate test for detecting deep vein thrombosis. It is nearly 100% sensitive and specific in making this diagnosis. (Pulmonary embolism is diagnosed in other ways.) Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a potentially fatal condition.

Phlebography is not used often; however, because it is painful, expensive, time-consuming, exposes the patient to a fairly high dose of radiation, and can cause complications. In about 5% of cases, there are technical problems in conducting the test.

Phlebography takes 30-45 minutes, and can be done in a physician’s office, a laboratory, or a hospital. During the procedure, the patient lies on a tilting x-ray table. The area where the catheter will be inserted is shaved, if necessary, and cleaned. In some cases, a local anesthetic is injected to numb the skin at the site of the insertion. A small incision may be required to make a point for insertion. The catheter is inserted and the contrast solution (or dye) is slowly

KEY TERMS

Contrast solution— A liquid dye injected into the body that allows structures, including veins, to be seen by x rays. Without the dye, the veins could not be seen on x rays.

Deep vein thrombosis— The development or presence of a blood clot in a vein deep within the leg. Deep vein thrombosis can lead to pulmonary embolism.

Invasive— A diagnostic test that invades healthy tissue; in the case of phlebography, through an incision in a healthy vein.

Pulmonary embolism— An obstruction of a blood vessel in the lungs, usually due to a blood clot that blocks a pulmonary artery. A pulmonary embolism can be very serious and in some cases is fatal.

injected. Injection of the dye causes a warm, flushing feeling in the leg that may spread through the body. The contrast solution may also cause slight nausea. Approximately 18% of patients experience discomfort from the contrast solution.

In order to fill the deep venous system with dye, a tight band (tourniquet) may be tied around the ankle or below the knee of the side into which the dye is injected, or the lower extremities may be tilted. The patient is asked to keep the leg still. The physician observes the movement of the solution through the vein with a fluoroscope. At the same time, a series of x rays is taken. When the test is finished, fluid is injected to clear the contrast from the veins, the catheter is removed, and a bandage is applied over the injection site.

Preparation

Fasting or drinking only clear liquids is necessary for four hours before the test, although the procedure may be done in an emergency even if the patient has eaten. The contrast solution contains iodine, to which some people are allergic. Patients should tell their physician if they have allergies or hay fever, or if they have had a reaction to a contrast solution.

Aftercare

Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. The physician should be notified if there is swelling, redness, pain, or fever. Pain medication is rarely needed. In most cases, the patient can resume normal activities the next day.

Risks

Phlebography can cause complications such as phlebitis, tissue damage, and the formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the dye. This usually happens within 30 minutes after injection of the dye, and requires medical attention.

Normal results

Normal phlebography results show proper blood flow through the leg veins.

Abnormal phlebography results show well-defined filling defects in veins. These findings confirm a diagnosis of deep vein thrombosis:

• blood clots
• consistent filling defects
• an abrupt end of a contrast column
• major deep veins that are unfilled
• dye flow that is diverted

Resources

BOOKS

Abeloff, MD et al. Clinical Oncology. 3rd ed. Philadelphia: Elsevier, 2004.

Grainger RG, et al. Grainger & Allison’s Diagnostic Radiology: A Textbook of Medical Imaging. 4th ed. Philadelphia: Saunders, 2001.

Khatri, VP and JA Asensio. Operative Surgery Manual. 1st ed. Philadelphia: Saunders, 2003.

Mettler, FA. Essentials of Radiology. 2nd ed. Philadelphia: Saunders, 2005.

Townsend, CM etal. Sabiston Textbook of Surgery. 17th ed. Philadelphia: Saunders, 2004.

OTHER

“Lower-Limb Venography.” Test Universe Website. 11 July 2001. http://www.testuniverse.com/mdx/MDX-2970.html.

Springhouse Corporation. “Catching Deep Vein Thrombosis in Time: Diagnostic Tests at a Glance.” SpringNet. 2001. 11 July 2001. http://www.springnet.com/ce/p507bs4.htm.

Lee A. Shratter, M.D.

Lori De Milto

Stéphanie Islane Dionne

Phlebography

Definition

Phlebography is an x ray test that provides an image of the leg veins after a contrast dye is injected into a vein in the patient's foot.

Purpose

Phlebography is primarily performed to diagnose deep vein thrombosis—a condition in which clots form in the veins of the leg. Pulmonary embolism can occur when those clots break off and travel to the lungs and pulmonary artery. Phlebography can also be used to evaluate congenital vein problems, assess the function of the deep leg vein valves, and identify a vein for arterial bypass grafting. Ultrasound has replaced phlebography in many cases; but phlebography is the "gold standard," or the best test by which others are judged, even though it is not used routinely.

Description

Phlebography (also called venography, ascending contrast phlebography, or contrast phlebography) is an invasive diagnostic test that provides a constant image of leg veins on a fluoroscope screen. Phlebography identifies the location and extent of blood clots, and enables the condition of the deep leg veins to be assessed. It is especially useful when there is a strong suspicion of deep vein thrombosis, after noninvasive tests have failed to identify the disease.

Phlebography is the most accurate test for detecting deep vein thrombosis. It is nearly 100% sensitive and specific in making this diagnosis. (Pulmonary embolism is diagnosed in other ways.) Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a potentially fatal condition.

Phlebography is not used often; however, because it is painful, expensive, time-consuming, exposes the patient to a fairly high dose of radiation, and can cause complications. In about 5% of cases, there are technical problems in conducting the test.

Phlebography takes 30–45 minutes, and can be done in a physician's office, a laboratory, or a hospital. During the procedure, the patient lies on a tilting x ray table. The area where the catheter will be inserted is shaved, if necessary, and cleaned. In some cases, a local anesthetic is injected to numb the skin at the site of the insertion. A small incision may be required to make a point for insertion. The catheter is inserted and the contrast solution (or dye) is slowly injected. Injection of the dye causes a warm, flushing feeling in the leg that may spread through the body. The contrast solution may also cause slight nausea. Approximately 18% of patients experience discomfort from the contrast solution.

In order to fill the deep venous system with dye, a tight band (tourniquet) may be tied around the ankle or below the knee of the side into which the dye is injected, or the lower extremities may be tilted. The patient is asked to keep the leg still. The physician observes the movement of the solution through the vein with a fluoroscope. At the same time, a series of x rays is taken. When the test is finished, fluid is injected to clear the contrast from the veins, the catheter is removed, and a bandage is applied over the injection site.

Preparation

Fasting or drinking only clear liquids is necessary for four hours before the test, although the procedure may be done in an emergency even if the patient has eaten. The contrast solution contains iodine, to which some people are allergic. Patients should tell their physician if they have allergies or hay fever, or if they have had a reaction to a contrast solution.

Aftercare

Patients should drink large amounts of fluids to flush the remaining contrast solution from their bodies. The area around the incision will be sore for a few days. The physician should be notified if there is swelling, redness, pain, or fever. Pain medication is rarely needed. In most cases, the patient can resume normal activities the next day.

Risks

Phlebography can cause complications such as phlebitis, tissue damage, and the formation of deep vein thrombosis in a healthy leg. A rare side effect in up to 8% of cases is a severe allergic reaction to the dye. This usually happens within 30 minutes after injection of the dye, and requires medical attention.

Normal results

Normal phlebography results show proper blood flow through the leg veins.

Abnormal phlebography results show well-defined filling defects in veins. These findings confirm a diagnosis of deep vein thrombosis:

• blood clots
• consistent filling defects
• an abrupt end of a contrast column
• major deep veins that are unfilled
• dye flow that is diverted

Resources

books

DeBakey, Michael E., and Antonio M. Gotto, Jr. "Invasive Diagnostic Procedures." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997, 78.

"Phlebography." In Mayo Clinic Practice of Cardiology, 3rd ed. St. Louis, MO: Mosby, 1996, 1840-1.

Texas Heart Institute. "Diseases of the Peripheral Arteries and Veins." In Texas Heart Institute Heart Owner's Handbook. New York: Wiley & Sons, 1996.

"Venous Imaging." In Diagnostic Nuclear Medicine, 3rd ed., Vol. 1. Baltimore, MD: Williams & Wilkins, 1996, 586-7.

periodicals

Barloon T. J., G. R. Bergus, and J. E. Seabold. "Diagnostic Imaging of Lower Limb Deep Venous Thrombosis." American Family Physician 56 (September 1, 1997): 791-801.

Tapson, Victor F. "Pulmonary Embolism—New Diagnostic Approaches." New England Journal of Medicine 336 (May 15, 1997).

other

"Lower-Limb Venography." Test Universe Website. 11 July 2001. <http://www.testuniverse.com/mdx/MDX-2970.html>.

Springhouse Corporation. "Catching Deep Vein Thrombosis in Time: Diagnostic Tests at a Glance." SpringNet. 2001. 11 July 2001. <http://www.springnet.com/ce/p507bs4.htm>.

Lee A. Shratter, M.D. Lori De Milto Stéphanie Islane Dionne