Venography Rt 255 Spring rev 2010 Week 10 (11)– Mon D. Charman
pg 1
(See Power point lecture for additional information on the NOTES preview)
Purpose of Venography
Venography is an x-ray exam that provides an image of the veins (leg) after a contrast is injected into a vein
in the patient's foot
Enables the condition of the deep leg veins to be assessed
Primarily performed to diagnose deep vein thrombosis DVT
Indications
Distinguish blood clots from obstructions in the
veins
Evaluate congenital vein problems
Assess the functioning of deep leg vein valves
Identify a vein for arterial bypass grafting
(CABG)
Deep vein thrombosis (DVT)
is a common but elusive illness that can result in suffering and death if not recognized and treated effectively.
DVT occurs in ~2 million Americans each year.
 Death can occur when the venous thrombi break off and form pulmonary emboli, which pass to and obstruct
the arteries of the lungs.
 DVT and pulmonary embolism (PE) most often complicate the course of sick, hospitalized patients but may
also affect ambulatory and otherwise healthy persons.
Deep vein thrombosis is a major complication in orthopedic surgical patients and patients with cancer and
other chronic illnesses.
DVT can be a chronic disease.
Patients who survive the initial episode of DVT are prone to chronic swelling of the leg and pain because the
valves in the veins can be damaged by the thrombotic process, leading to venous hypertension.
LOWER LIMB DVT
Venous thrombosis in the lower limb can involve
the superficial leg veins,
the deep veins of the calf (calf vein thrombosis),
the more proximal veins,
including popliteal veins,
PE:
the
superficial femoral, common femoral, and iliac
veins.
Less commonly, thrombosis involves other veins
in the body
Pulmonary Embolism
It is estimated that each year 600, 000 patients develop PE
and that 60,000 die of this complication.
This number exceeds the number of American women who die each year from breast cancer.
PE is now the most frequent cause of death associated with childbirth. Women are a prime target
for PE, being
affected more often than men.
Occurs when a clot forms or becomes lodged in the pulmonary artery
Most commonly thrombus originates in the lower limbs and migrates
Can lead to resp distress, heart failure or cardiogenic shock
Symptoms are acute:
Sudden coughing
SOB
Chest pain
DVT vs. PE
DVT usually occurs in lower leg.
Impedes normal blood flow.
DVT is stationary.
PE is the result of a DVT breaking apart.

Venography Rt 255 Spring rev 2010 Week 10 (11)– Mon D. Charman
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The Danger of PE’s: 3rd leading cause of cardiovascular death in U.S.
Venous Thrombosis : CH 8 Pathology
venous thrombosis- the formation of blood clots within a vein
These clots commonly form in the veins of the lower extremities and result from a slowing of the blood return
to the heart.
The contraction of the leg muscles assists with venous blood return; therefore, postoperative or bedfast patients
are especially prone to this disorder.
Phlebitis, an inflammation of the vein, is often associated with venous thrombosis - the combination of these
disorders is thrombophlebitis.
The thrombus formation generally begins in the valves of the deep calf veins where thromboplastin traps red
blood cells to create the blood clot. Patients may be placed on anticoagulant drugs or receive thrombolytic
therapy.
Venous Thrombosis
Cause
Thrombus
Incidence
Thrombophlebitis
Phlebitis
Deep Vein Thrombosis
Primarily involves lower limbs
Major source of fatal PE
Risks
Restricted mobility
Surgery
Obesity
Pregnant
BC
pills
trips
Plane
Car
Long
Thrombosis
&
Embolism
Intravascular clot
Commonly in veins more than arteries
3 factors
Where blood is slow
Change in the wall of vessels
Change in the blood itself
Thrombus that becomes detached from the vessel wall
Can easily flow to heart causing PE
Severity depends on location of embolism
Varicose Veins are diseased blood vessels that have become permanently dilated and can no longer efficiently
carry blood back to the heart
Dilated, elongated and tortuous vessels
Most common to superficial veins of leg
Multiple bluish nodules just under skin
Development of collateral veins
Valves are unable to prevent backflow
Valves cease to function increasing blood volume is these veins
Arteries carry blood away from the heart while veins return blood back to the heart.
Varicose veins can arise when this system gets backed up
Multiple round and oval calcifications in soft tissues (phleboliths) represent calcified thrombi
Shows the degree of collateral circulation
Demonstrates patency of the deep venous system
Venography Rt 255 Spring rev 2010 Week 10 (11)– Mon D. Charman
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Spider Veins
Risk factors for spider veins are similar to those for varicose veins –
 age, heredity, pregnancy, hormonal changes, obesity and extended periods of standing –
as well as sun exposure, particularly in fair-skinned people, and injuries to the skin surface.
Some physicians believe that exercise, weight loss and the wearing of support hose and flat shoes instead of
high heels can reduce the incidence of spider veins.
Phlebitis
Inflammation of a vein
Often associated with venous thrombosis
US usually used to diagnose
Treated with anticoagulants

Prior to Procedure
Pt should fast or drink only clear fluids for four hours before the test - WHY
Thorough PT history obtained
Informed consent
If pt is nervous about the doctor may give a sedative.
Explanation of Procedure: Legs
The catheter is inserted into PT vein
 (usually a vein in the foot)
Contrast is slowly injected.
Tourniquet may be tied around the ankle of the
foot the contrast is injected into - may also place
one on the thigh
The procedure takes about 30 - 45 minutes
Contrast injected into top of foot
 Local anesthetic
May be unilateral or bilateral
FILMING
VARIES WITH RADIOLOGIST
MAY NEED SCOUT FILMS
14 X 17 Cassettes starting at
Ankles, Knees, Femurs, Pelvis,
Abdomen & Chest may also be taken
What will the ABD film demonstrate?
Flush with saline mark syringe w/ band aid
The patient is asked
 to keep the leg still
 Radiologist may
use fluoroscopy
A series of images
taken via fluoro and/or
overheads films are taken
fill the deep venous system with contrast
The body may be tilted
(Delay 15 Min – IVP Film)
Overheads or
14x14 Fluoro Cassettes
Or Digital
Images taken With & Without Tourniquet

Atherosclerosis Left Leg: Arterial Study

CONTRAST MEDIA
Contrast
Injectable
Water Soluable
Ionic
Vs Non Ionic
Venous Injection
Saline
Strength
Sterile
Labeled
Stings during injection
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.
Venography Rt 255 Spring rev 2010 Week 10 (11)– Mon D. Charman
Risks & Complications
phlebitis / infection at injection site
tissue damage
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 contrast.
This usually happens within 30 minutes after injection
Congestive heart failure
Acute renal insufficiency
Venous thrombosis in a healthy leg
Dislodging a clot, perhaps resulting in pulmonary embolus or other complications
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Abnormal results
Abnormal venography results show well-defined filling defects in veins
Findings include:
Blood clots
Major deep veins that are unfilled
Consistent filling defects
Contrast flow that is diverted - These results
An abrupt end of a vessel
confirm a diagnosis of deep vein thrombosis.
Types of Other Venogram Procedures
Leg (lower extremity) MOST COMMON
Arm (upper extremity)
Inferior Vena Cavagram
Superior Vena Cavagram
Adrenal
Renal
Saphenous
Vein
Catheter injection directly for upper leg
DVT of Iliac Vein: On x-ray appears as a constant filling defect
Largely replaced by duplex color doppler ultrasound - Demonstrates the velocity of the venous blood flow
Post Femoral Vein Puncture Orders
Bed rest for 2-4 hours with affected leg straight.
(Physician will specify)
Check puncture site for sign of bleeding.
Check
B.P. q 1 hour x 4 hours.
fluids.
Resume pre-venography activity
Encourage
Arteriogram – subclavian injection
Review Anatomy of Upper Limb (RT 255 & 93
Inferior Vena Cavogram
 To view the inferior vena cava to determine strictures, tumor blockage and location of blood clots.
A catheter is inserted in the femoral vein & positioned in the common iliac vein or the inferior aspect of the
inferior vena cava.
•The contrast is injected through a multiple side hole catheter.
An IVC Filter is a “wire basket” that is used to trap emboli.
Several types available
Indications for IVC Filter
Existing deep vein thromboses, history of
pulmonary embolism.
Surgical weight loss.
Some
cancer patients.
anticoagulation therapy is contraindicated.
Prolonged bed rest/ immobility.
When
Venography Rt 255 Spring rev 2010 Week 10 (11)– Mon D. Charman
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IVC Filter Placement
therapy contraindicated.
•Utilized to trap deadly
This Procedure SAVES Lives.
Pulmonary Embolism’s
RISKS – CAN PUNCTURE!
•Filter placed when anticoagulation
Use of carbon dioxide (CO2) as a contrast medium is demonstrated (appearing white along the right of
the spine) on a frail 75-year-old man.
Superior VenaCavogram example
Post- Procedure CareApply pressure to puncture site 5-20 min.
Patient monitored 6-8 hours in hospital.
BEDREST.
Watched
Minimal
for hematoma.
activity for the 1st couple of days after
discharge.
Leg Venography & Other Modalities
is nearly 100% sensitive and specific in making this diagnosis (pulmonary embolism is diagnosed in other
ways).= HOW?
Accuracy is crucial since deep vein thrombosis can lead to pulmonary embolism, a condition that can be fatal.
It is especially useful when there is a strong suspicion of deep vein thrombosis, but non-invasive tests
(ultrasound) have failed to identify the disease.
Doppler U.S. used to determine presence of DVT.
MRI & CT can also be used.
Fluoroscopy in the Angio suite used for insertion of filters for IVC.
Venography is not used often, because it is painful & expensive
Venography takes between 30-45 minutes
+ up to 10 min of beam on – fluoro time
 May be done in a physician's office, or a hospital.
US – Now modality of choice
Unless results are inconclusive
PROCEDURES DONE w/ US
Peripheral Vascular Ultrasound
Carotid Ultrasound
Upper/Lower Arterial Evaluation
Renal Duplex Imaging
Upper/Lower Venous Evaluation
It
VASCULAR ULTRASOUND: non-invasive - no contrast no radiation
BENEFITS
RISKS
Less Expensive ?
Non Invasive/Painless
(If No Health Problems)
Soft Tissue Visualized
Tortuous Veins Well Visualized
Sometimes Inconclusive or Unclear
Has Replaced Venography
Vein Is Totally Closed Off Or Not?
Capable Of Replacing Angio Someday (?)
Unable To See Deep Vessels