Venography (also called phlebography or ascending phlebography) is a procedure in which an

X-ray An X-ray (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

of the

vein Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and feta ...

s, a venogram, is taken after a special dye is injected into the

bone marrow Bone marrow is a semi-solid biological tissue, tissue found within the Spongy bone, spongy (also known as cancellous) portions of bones. In birds and mammals, bone marrow is the primary site of new blood cell production (or haematopoiesis). It i ...

or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure. Normally the catheter is inserted by the groin and moved to the appropriate site by navigating through the vascular system. Contrast venography is the

gold standard A gold standard is a backed currency, monetary system in which the standard economics, economic unit of account is based on a fixed quantity of gold. The gold standard was the basis for the international monetary system from the 1870s to the ...

for judging diagnostic imaging methods for

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enl ...

; although, because of its cost, invasiveness, and other limitations, this test is rarely performed. Venography can also 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, or to identify a vein for arterial bypass grafting. Areas of the

venous system Veins () are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal c ...

that can be investigated include the lower extremities, the

inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...

, and the upper extremities. The United States

National Institute of Health The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. It was founded in 1887 and is part of the United States Department of Health and Human Servic ...

says the following about

varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...

, "they cause concern and distress on a large scale, most of which can be dealt with by good explanation and reassurance, or by a variety of treatments which are evolving rapidly at present."

Peripheral venography

Upper limb

Upper limb venography is indicated in those who has upper limb oedema, to demonstrate site of occlusion and stenosis in the veins, and superior vena cava obstruction. Low osmolar contrast medium with concentration of 300 mg/ml is used. The subject lies down in supine position. An 18G butterfly needle is inserted into the median cubital vein.

Cephalic vein In human anatomy, the cephalic vein (also called the antecubital vein) is a superficial vein in the arm. It is the longest vein of the upper limb. It starts at the anatomical snuffbox from the radial end of the dorsal venous network of hand, a ...

is not used because it bypasses the axillary vein. Then, 30 ml of the contrast is injected through the butterfly needle and spot images are taken. Alternatively, digital subtraction angiography can be used at a fram rate of 1 frame per second.

Lower limb

Lower limb venography is indicated in

, oedema with unknown cause, and congenital abnormality of the venous system. Less frequently it is used to demonstrate the incompetent valves of perforating veins. Doppler ultrasound is preferable rather than venography to access the competence of the veins. Local

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

of the lower limbs is contraindicated for this procedure. Low osmolar

contrast agent A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radiop ...

with concentration of 240 mg/ml is preferable in this study. Before the procedure, oedematous leg, if any, should be elevated overnight to reduce the oedema. The subject is tilted 40 degrees with head higher than the legs, in order to delay the flow of contrast medium from the foot to the thigh. Tourniquet is applied over the ankle to occlude the

superficial vein Superficial veins are veins that are close to the surface of the body, as opposed to deep veins, which are far from the surface. Superficial veins are not paired with an artery, unlike the deep veins, which are typically associated with an art ...

s of the leg.

Anterior tibial vein The anterior tibial vein is a vein in the lower leg. In human anatomy, there are two anterior tibial veins. They originate and receive blood from the dorsal venous arch, on the back of the foot and empties into the popliteal vein. The anterior ...

is also occluded. 19G butterfly needle is inserted into dorsum of foot at a distance from the ankle. 40 ml of contrast medium is injected by hand. Spot films are then taken. Then, another 20 ml of contrast medium is injected.

Valsalva maneuver The Valsalva maneuver is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut while expelling air, as if blowing up a balloon. Variations of the maneuver can be ...

is performed to delay the flow of contrast medium into the thigh. Then, the subject is tilted in head down position and Valsalva maneuver is relaxed for contrast medium to flow into the pelvis. Alternatively,

femoral vein In the human body, the femoral vein is the vein that accompanies the femoral artery in the femoral sheath. It is a deep vein that begins at the adductor hiatus (an opening in the adductor magnus muscle) as the continuation of the popliteal v ...

can be pressed during the tilting and released after tilting is completed to achieve the same effect. At the end of the procedure, the needle is flushed with normal saline to reduce the chances of getting

phlebitis Phlebitis (or venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis (clotting inside blood vessels) and is then called thrombophlebitis or ...

due to administration of contrast medium.

References

External links

Baylor College of Medicine Venogram procedure page, retrieved November 4, 2006

WebMD Venogram procedure page, retrieved November 4, 2006
{{Medical imaging Projectional radiography

Peripheral venography

Upper limb

Lower limb

See also

References

External links