Peripheral venography

Niraj sapkota
BSc.MIT 2017 batch
 Venography is an radiological invasive procedure or examination of vein by
intravenous injection of contrast media.

 Contrast venography is the gold standard for judging diagnostic imaging

methods for deep venous thrombosis ; although, because of its cost, the
increased sensitivity of sonography to demonstrate pathology and other
limitations this test is rarely performed.

 The commonly done venography is peripheral venography.

 Peripheral venography is the study of veins of the extremities by injecting

CM intravenously.
Lower limb venography
 it is the study of the veins of lower limb by injecting CM
intravenously.

 Methods: intravenous venography

 Indications:
 Oedema of unknown cause
 Deep vein thrombosis
 Varicose vein
 Venous incompetence
 Venous malformation
 Congenital abnormalities of the venous system.

 Contra-indication:
 Local sepsis
 Allery to iodine
 Equipment:
 Fluoroscopy unit with spot film device & tilting radiography table
 Tourniquet
 Butterfly needle 23G
 Syringes

 Contrast medium:
 LOCM 240 mgI/ml, 40-50ml

 Patient preparation:
 NPO for 5-6 hours
 Check serum creatinine level
 Elevate leg overnight if edema is severe
 Informed consent should be taken
 Technique:

 Patient is placed in supine position on the x-ray table with all elastic wrapping removed from the
leg.
 Tilted head up 40 degrees head up, to delay the transit time of the CM.
 Technique is either ascending or descending. For ascending technique – the tourniquet is applied
just above the ankle joint and below the knee to occlude the superficial system and direct flow into
the deep veins.
 Then 23 G butterfly needle is inserted into the vein of dorsum of foot.
 About 40 ml of CM is injected by hand then following sequences of film are taken.
 AP of tibia region or calf
 Both oblique of calf (foot internally & externally rotated.
 AP of popliteal, common femoral and iliac veins.
 The table is lowered and another film is taken of legs to determine the degree of stasis.
 At the end of procedure, the needle should flushed with normal saline to prevent contrast stasis &
the risk of phlebitis.
 Descending technique is uncommon and done with femoral vein punctured.
 After care:
 The limb should be exercised.

 Complications:
 Due to CM:
 Allergic reaction
 Thrombophlebitis
 Tissue necrosis due to extravasation of CM (rarely)
 Cardiac arrhythmia

 Due to technique:
 Haematoma
 Pulmonary embolus due to dislodged clot or
injection of excessive air
Upper limb venography
 it is the study of the veins of upper limb by injecting CM
intravenously.

 Method: intravenous venography

 Indications:
 Oedema
 Venous occlusion or stenosis
 Superior vena cava obstruction
 Congenital abnormalities of venous system

 Contraindications:
 Allery to iodine

 Equipment:
 Fluoroscopy unit with spot film device
 Touniquet
 Butterfly needle 18 G
 Syringes
 Contrast medium:
 LOCM 300 mgI/ml, 30 ml

 Patient preparation:
 NPO for 5-6 hours
 Check serum creatinine level
 Informed consent should be taken

 Technique:
 The patient is supine.
 An 18 G butterfly needle is inserted into the median
cubital vein at the elbow. The cephalic vein is not used,
as this bypasses the axillary vein.
 Spot film are taken of the region of interest during a
hand injection of 30 ml of CM. alternatively, a digital
subtraction angiographic run can be performed at 1
frame/sec.

 After care: none

 Complications:
 Due to CM:
 Allergic reaction
 Thrombophlebitis
 Tissue necrosis due to extravasation of CM (rarely)
 Cardiac arrhythmia

 Due to technique:
 Haematoma
 Pulmonary embolus due to dislodged clot or injection
of excessive air.