At the present stage of development of medical science, many acute and chronic diseases associated with the defeat of the venous system of the lower limbs are known.
Certainly, their timely and accurate diagnosis is an obligatory measure for successful treatment in the future without a significant decrease in the quality of life of patients.
And one of the highly informative diagnostic procedures is the conduct of phlebography( venography).
What is this
This type of diagnostic activities is X-ray study method using contrast medium , in which the aim is to assess the conditionI have deep veins of the lower extremities.
It is also referred to as ascending phlebography , since the contrast injected intravenously extends through the venous network from the bottom up.
What is the purpose of it?
Phlebography is needed directly to confirm the diagnosis "deep vein thrombosis of the lower extremities" and differentiate it with other types of pathologies to choose the right tactics of therapy for a particular patient.
Also, the study in many ways helps doctors in identifying varicose veins, phlebitis, thrombophlebitis and post-thrombotic disease. Undoubtedly, for the differentiation of these diseases specialists resort to other methods of comprehensive examination of patients, but venography remains a highly informative technique.
What can I see when conducting a phlebography?
First of all, this procedure allows us to consider the presence and severity degree of deep veins of the lower extremities , including communicating vessels, to suspect a pathological discharge of venous blood from them into the system of superficial veins of the legs, to inspect the valve venous apparatus.
In addition, phlebography brightly visualizes the congenital anomalies of the structure of the venous network .In the presence of pathology, the doctor can see the following changes:
- Defects in the filling of the venous system.
- Change the direction of the contrast agent.
- An unexpected break in the spread of contrast.
Basic indications and contraindications
Experts recommend phlebographic examination of leg veins for those people who have suspicions of venous pathology, as well as those who already have it in the history to assess the stage of the disease at the moment. Indications include:
- deep vein thrombosis;
- varicose veins;
- address the issue of the possibility of intravenous injection of sclerosants;
- search for an embolic thrombus;
- postthrombophlebitic syndrome;
- expressed edematous syndrome.
The procedure is contraindicated if the patient has:
- of the individual's hypersensitive reactions to the components of contrast medium in the form of urticaria, angioedema, bronchospasm, Quincke's edema;
- foci of trophic disorders( ulcers, necrosis), marked rashes and scars at the site of presumed needle insertion;
- exacerbation of chronic kidney and liver diseases;
- pregnancy( with caution);
- of oncological diseases;
- of the elderly;
- thromboembolism;
- atherosclerosis of the vessels of the lower extremities.
Patient Preparation The patient is sent to the holding of ascending venography, should be fully aware medical personnel about the purpose for which the research will be carried out. The patient is described the essence of the method, its main stages and the need for this manipulation in its specific case.
The doctor also explains that a certain kind of preparation is required before the procedure, and during it may appear uncomfortable sensations of ( burning sensation when intravenously injecting contrast medium, discomfort during subsequent actions).
Preparatory activities include:
- Patient's refusal to eat at least 4-5 hours before taking phlebography( drink liquids allowed).
- Laboratory tests to assess the functional state of the kidneys and the blood coagulation system( general blood test and urinalysis with an assessment of the level of creatinine, urea, uric acid and ions, biochemical blood test, coagulogram, determination of APTTV and MNO).
- Immediately before the writing, the patient urinates, takes off all the clothes below the waist( it is recommended to put a robe on top).
Doctor warns about possible side effects venography ( phlebitis, inflammation and necrotic tissue changes around the puncture site, thrombosis), and that if the patient feels nausea, severe burning or itching, pressing pain in the throat or chest, shortness of breath, you mustImmediately report this to the specialist who conducts the procedure.
How the
study is performed The patient is placed in the with the vertical position of the on a specialized X-ray table, while the lower limb that will be subjected to the procedure is deprived of support function. After relaxing
legs superimposed rubber band in the ankle area to contrast material more easily filled venous bed in the future.
Find one of the superficial veins and into it is introduced a physiological solution, and then slowly and carefully allowed contrast agent in a volume of about 150 ml , then carefully checking the state of the surrounding soft tissue to avoid vein entry by the needle.
While the contrast agent is distributed through the venous vessels, this is followed by an X-ray machine. Produce a series of images in the anterior, posterior, oblique projections. Remove the areas of the hip, groin, lower leg, knee joint.
After this, the X-ray table is transferred to the horizontal location of the , while the lower limb is shown to rapidly elevate and inject saline to accelerate the washout of the contrast from the venous network. Conducting a control fluoroscopy is confirmed by the complete removal of contrast, the puncture needle is removed, a plaster bandage is applied.
During venenography, medical personnel monitor the pulse on the arteries of the lower extremity( artery of the rear of the foot, popliteal and femoral arteries), are given analgesic drugs .
After the study, the patient must be closely monitored because of the possibility of developing late allergic reactions. The bandage is monitored and replaced on a timely basis. To accelerate the output of contrast with the urine, the patient is recommended to drink plenty of alkaline, full-value food can be renewed by .
Analysis of the results
The results of this diagnostic procedure are imprinted on phlebograms( roentgenograms of the venous network). Specialist evaluates:
- state of venous wall
- state of valvular apparatus
- uniformity and usefulness of filling vessels with contrast medium
- presence of contrast reflux into superficial veins
- typical of anatomical structure of leg veins( revealing anatomical abnormalities).
With normal patency and the structure of venous vessels, the is determined uniformly over the entire length of the without any defects in the filling of the contrast medium. In pathology, there are some changes in the above parameters.
It is worth remembering that on the reliability of the results determining the presence of a norm or pathology is affected by :
- Incomplete relaxation of the lower limb and its movement during the procedure.
- Reliance on the limb.
- Lack of injected contrast medium.
- A tight tourniquet on the ankle.
- Untimely taking pictures during the procedure.
- Swelling of soft tissues of the foot.
Possible deviations from the norm
Include the definition of blood clots( clots), constant defects of filling with contrast medium( it does not stain those areas of veins, on the way to which there is an obstruction), sudden tearing of the pattern created by contrast, a low degree of filling of the deep veins, staining by contrast of atypical zones.
Price policy
The venography of the veins of the lower extremities is not a screening standard test method. Moreover, it refers to the rather expensive procedures of because of the use of expensive devices and contrast, as well as the requirements of the high professionalism of the conducting research of medical personnel.
On average, in the Russian Federation, phlebography costs 15,000 rubles( from 9,000 rubles to 25,000 rubles , depending on the location, status and equipment of the medical organization).However, there are clinics in which this study costs and 3000-5000 rubles.
In any case, phlebography remains not the cheapest diagnostic technique. Abroad, the study of the venous leg system has a cost, which is about three times higher than the Russian prices of .In any case, the choice of patients for the venography of phlebography remains individual.
Phlebography, being highly informative and rather specific method of diagnosing of diseases of the veins of the lower extremities, remains very valuable for patients with problems of this genus. Of course, it can be replaced by procedures such as ultrasound dopplerography, plethysmography, but it is venography that gives such a detailed picture of the veins and all the pathological changes in their structure.
But with the full knowledge of physicians and the correct technique of performing phlebography, the results will necessarily bring their diagnostic value to the process of examining the patient.