Phlebography

Varicose veins, phlebothrombosis and post-thrombotic disease are often the lesions of the veins of the lower limbs leading to chronic venous insufficiency. They conceal the danger of transferring thrombotic masses into the vessels of the lungs with the development of their thromboembolism and pulmonary infarction.

In the examination of persons with venous insufficiency of the limbs, the leading role is played by impedance plethysmography and radiation methods (X-ray phlebography). These studies are necessary not only for diagnosis, but even more to clarify the location, extent, type and extent of the lesion, including valvular valve evaluation.

In chronic venous insufficiency, it is necessary to examine the venous system of both extremities, since phlebothrombosis of one of them can be asymptomatic. The priority belongs to the ultrasound method due to its availability and high diagnostic value, but in some cases it does not allow to distinguish between acute and chronic vein thrombosis. X-ray phlebography is a sensitive and highly specific method of diagnosing venous insufficiency, but it is contraindicated in acute thrombophlebitis, renal insufficiency and high sensitivity to iodide preparations. Radionuclide phlebography (phleboscintigraphy) for sensitivity and specificity is somewhat inferior to X-ray phlebography, but it is less traumatic, has no contraindications, does not threaten the dislocation of a thrombus and is accompanied by a lower radiation load.

X-ray phlebography is performed in different positions of the patient - horizontal and vertical. With vertical functional-dynamic phlebography, the first image is taken after filling the veins of the shin, the second after the limb muscle contraction (for this, the patient is asked to rise several times on his toes), the third immediately after the second, during the relaxation phase of the musculature. Recently, in well-equipped centers, magnetic resonance phlebography and computer tomography angiography on spiral computer tomographs have been successfully used.

Uncombined veins cause a clear network of blood vessels on X-rays. The vein usually goes straight, sometimes forms small bends; Its lumen is uniform, slightly enlarged in front of the valves. The contours of all veins are sharp and even. Interstitial anastomoses are represented by short veins with a uniform lumen. Insufficiency of the deep veins is manifested by their expansion and tortuosity with a persistent slowing of the blood flow. With the inadequacy of communicative veins, the contrast agent is thrown from the deep veins into the superficial veins. Phlebitis leads to a persistent narrowing of the vessel, and the parietal thrombus forms an edge filling defect. When a thrombus is found, the question arises about the prevention of pulmonary embolism. For this purpose, the lower vena cava is catheterized and a special filter mesh is installed to hold the possible thrombus when it migrates from the veins of the lower extremities.

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