In the frequent leg phlebography, a contrast medium is injected into a dorsal foot vein ( vena dorsalis pedis ) on the standing patient after a tourniquet has been created above the ankle and an X-ray image (s) of the leg is taken. Arm phlebography is possible analogous to this procedure. Thromboses (blockages caused by blood clots ) can be recognized by contrast medium recesses in the course of the vessels . Varices ( varicose veins ) and their causes can also be recognized in the phlebogram . Other veins, especially those of the arm, can also be displayed as peripheral veins by injecting contrast medium.
In medicine, the examination procedure is often used as a complement or in addition to (duplex) sonography if it does not result in a conclusive diagnosis. The method still has advantages, especially in the thin, branched veins of the lower leg / forearm, with complex varicose veins (varicose veins), after severe thrombosis (so-called post- thrombotic syndrome ) and on venous valves . In preparation for varicose vein operations in particular , venography is still requested because it provides reliable information and presentation of findings.
Furthermore, in rarer cases, a venography of the large vena cava of the upper body ( superior vena cava ) or abdominal cavity ( inferior vena cava ) is performed using a similar technique, but with a larger amount of contrast medium or flow rate. This is also called the upper or lower cavography . With computed tomography (CT) or magnetic resonance tomography (MRT), these examinations are now more elegant and can be carried out with significantly more additional information.
Advantages of venography
The venography allows the complete representation of a (branched or complex) venous vascular system over a longer distance with the possibility of documenting functional features - for example when moving the extremities or changing the patient's position.
Disadvantages of venography
- Radiation exposure
- Contrast medium injection into vessels → risk of allergy
- Kidney strain from the contrast agent
- Device technology relatively expensive, location-dependent
- experienced specialist ( radiologist ) required
Nowadays, sonography is the method of choice for assessing the veins . For the detection or exclusion of thromboses, magnetic resonance tomography is another suitable method that does not cause radiation exposure, especially of the large-caliber veins of the groin, the thigh and the hollow of the knee. Due to the high costs, limited availability and the time required, MRI is rarely the first diagnostic measure when a thrombosis is suspected - especially since the large veins mentioned can also be assessed with excellent sonography. For the remaining veins, duplex / color Doppler sonography is used. The lack of radiation and contrast agent exposure are advantageous here. MRT or CT are also used for special questions (local differences depending on availability, equipment, experience, reputation).
- Axel W. Bauer : Santos Reynaldo dos. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (ed.): Enzyklopädie Medizingeschichte . De Gruyter, Berlin 2005, ISBN 3-11-015714-4 , p. 1285.
- Axel W. Bauer: Phlebology. In: Encyclopedia of Medical History. 2005, p. 1153 f .; here: p. 1154.
- X-ray examination of venous blood vessels (venography) patient information, Radiological Clinic of the University Hospital Bonn , accessed on August 18, 2018
- Jürgen Weber: "Phlebography: leg, pelvis. And abdominal veins in anatomy and function , Rabe Verlag, Bonn 2010, ISBN 978-3-940654-15-1 .