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 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, and to identify a vein for arterial bypass grafting.

  Precautions

Venography is usually 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, 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 will be shaved, if necessary, and cleaned. Sometimes a local anesthetic is injected to numb the skin at the site of the insertion. Sometimes a small incision is 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 (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 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. 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 can also 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.

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 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.

   Resources:

Books

• DeBakey, Michael E., and Antonio M. Gotto Jr. "Invasive Diagnostic Procedures." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997.
• Texas Heart Institute. "Diseases of the Peripheral Arteries and Veins." In Texas Heart Institute Heart Owner's Handbook. New York: Wiley & Sons, 1996.
• "Venography." In Mayo Clinic Practice of Cardiology. 3rd ed. St. Louis: Mosby, 1996.
• "Venous Imaging." In Diagnostic Nuclear Medicine. 3rd ed. Vol. 1. Baltimore: Williams & Wilkins, 1996.

Periodicals

• Barloon T. J., G. R. Bergus, and J. E. Seabold. "Diagnostic Imaging of Lower Limb Deep Venous Thrombosis." American Family Physician 56 (1 Sept. 1997): 791-801.
• Tapson, Victor F. "Pulmonary Embolism - New Diagnostic Approaches." New England Journal of Medicine 336 (15 May 1997).

Other

• "Venography Helps Patients Avoid Hospital Readmission." American Academy of Orthopaedic Surgeons Page. 24 Feb. 1996. 4 Mar. 1998 http://www.aaos.org
• "Catching Deep Vein Thrombosis in Time: Diagnostic Tests at a Glance." SpringNet. 11 Aug. 1997. 4 Mar. 1998 http://www.springnet.com/ce/p507bs4.htm