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Cuff-impedance phlebography and 125I fibrinogen scanning versus roentgenographic phlebography for diagnosis of thrombophlebitis following hip surgery. A preliminary report.

Seventy-eight limbs of forty-eight patients undergoing total hip replacement were studied by roentgenographic phlebography, cuff-impedance phlebography, and 125I fibrinogen scanning. Compared with roentgenographic phlebography, cuff-impedance phlebography detected seven of ten thrombi in the thigh but none of nine thrombi in the calf and popliteal veins, giving an over-all accuracy of 80 per cent. The 125I fibrinogen scanning technique detected none of the ten thrombi in the thigh and seven of the nine in the calf and popliteal veins, giving an over-all accuracy of 78 per cent. Combining the results of the two techniques, fourteen of the nineteen thrombi were detected. Cuff-impedance phlebography appears to be a useful method for the diagnosis of thrombi in the thigh after hip surgery.

Femoral Vein

A comparison between descending phlebography and duplex Doppler investigation in the evaluation of reflux in chronic venous insufficiency: a challenge to phlebography as the "gold standard".

To evaluate venous reflux in 56 lower limbs of 32 consecutive patients, hemodynamic tests, ascending and descending phlebography, and supine and erect quantitative duplex scanning were performed and the clinical severity was classified (class 0 = 15, class 1 = 19, class 2 = 8, and class 3 = 14). Of the 56 lower limbs, 22 (40%) had severe swelling and hyperpigmentation with or without ulcer (classes 2 and 3). Adequacy of the clinical severity classification was supported by the hemodynamic results. Radiologic and ultrasound findings were described by axial grading, multilevel/multisystem point, and multisegment scoring systems. Applying these evaluation systems, the phlebographic and scan results correlated poorly. There was no relationship between the radiologically obtained average reflux grade or points and the clinical severity. An erect quantitative duplex Doppler test assessed by the multisegment scoring system correlated best with the severity classification. The predictive value of this test to diagnose severe reflux leading to severe symptoms (classes 2 and 3) was 77% compared with 35% to 44% for descending phlebography. The study suggests that erect quantitative segmental duplex Doppler reflects the degree and distribution of venous reflux more accurately than does descending venography.

Humans

Colour duplex scanning and phlebography in deep vein thrombosis.

Clinical evaluation of deep venous thrombosis is often unreliable. Recently it has been shown that deep venous thrombosis may be detected with colour duplex scanning which is safer than phlebography. However it is not clear how colour duplex correlates with phlebography. One hundred and twenty consecutive patients with suspected deep vein thrombosis were studied by colour duplex scanning and phlebography to compare the two methods. Both tests were positive in 102 limbs and negative in 16 limbs. In two cases of below-knee thrombosis colour duplex was negative while phlebography showed small localised thrombosis. The sensitivity of colour duplex was 98%, its specificity and positive predictive value 100% and its negative predictive value 88.8%. In conclusion colour duplex appears to be as effective as phlebography in detecting deep venous thrombosis above knee.

Adult

[Phlebography of the legs].

On the basis of more than 10,000 phlebographies we believe that the ascending phlebography with control by means of x-rays and accurate photographs, the so-called "phleboscopy", is the most appropriate of all techniques of phlebography for a routine ambulant examination of the veins. By means of phlebography we succeed in employing our therapeutical measures accurately, control of therapeutic results is possible. The phlebography informs about the morphological condition of the veinous system and the defluxion conditions. It serves for determining pathological conditions, such as the post-thrombotical syndrom in the case of acute deep thrombosis of the crural veins, and informs about the extent and defluxion conditions of the varicose veins as well as the sufficiency or insufficiency of the Vv. perforantes.

Humans

A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography.

Twenty patients with portal hypertension due to cirrhosis were examined by esophagoscopy and percutaneous transhepatic esophageal phlebography. Esophageal varices were found in 18 cases at endoscopy and in 19 cases at esophageal phlebography. There was little correlation between the findings of the two methods with respect to the size and number of esophageal varices. At endoscopy the subepithelial and submucosal varices were reliably detected. At esophageal phlebography differentiation between intrinsic (i.e. subepithelial and submucosal veins) and peri-esophageal veins was not possible. Negative findings at esophageal phlebography do not rule out esophageal varices.

Adult

Renal occlusion phlebography: applicability of the balloon catheters.

The technique of selective renal occlusion phlebography using Swan-Ganz or Dotter-Lucas balloon catheters is described. The Swan-Ganz catheter is introduced into the femoral vein with the aid of a Cordis introducer system. The Dotter-Lucas balloon catheter is inserted via the same route using a combination of either a Desilets-Hoffman or Edslab introducer, along with a Gebauer introducer. Occlusion of the renal vein is achieved by insufflation of the balloon with air or injection of saline or dilute contrast media into the balloon. Selective renal occlusion phlebography was performed in 116 patients in order to exclude renal vein thrombosis, to delineate poorly vascularized renal masses, to determine the venous involvement of a renal tumor, and to assess the patency of splenorenal shunts. Renal occlusion phlebography optimizes the retrograde opacification of the renal veins. It has value in the delineation of poorly vascularized renal masses and in the determination of the venous involvement of renal and retroperitoneal tumors, and it would seem to be the method of choice for demonstrating the patency of surgical splenorenal shunts. Further enhancement of venous opacification by the combination of temporary arterial vasoconstriction with angiotensin (pharmaco-occlusion phlebography) and venous balloon occlusion is useful in some cases.

Adenocarcinoma

[Phlebography for pre- and posttherapeutic control of fibrinolysis and thrombectomy (author's transl)].

The indications for fibrinolysis or thrombectomy when there is suspected fresh ilio-femoral venous thrombosis should be based on accurate phlebography at the earliest possible moment. Early posttherapeutic phlebography under standardised conditions should be used to control further treatment. Later examinations document the final outcome. Early phlebography, when treatment has been discontinued and has been unsuccessful, shows the so-called "Rischhalte phenomenon", which may be an indication for further thrombectomy. Seven cases are reported in which primary fibrinolysis with streptokinase was followed by thrombectomy with a Fogarty catheter. 3-Step-phlebography provides the essential information which governs treatment and demonstrates its results.

Femoral Vein

[The value of renal phlebography in the differential diagnosis of arteriographically hypo- or avascular lesions in the kidney (author's transl)].

The present paper is an investigation into the diagnostic value of renal phlebography for differentiating between arteriographically hypo- and avascular malignant lesions in the kidney and benign renal masses. In three examinations carried out on eight patients with renal masses, phlebography was of crucial diagnostic importance. In ten renal cysts a presumptive diagnosis made by arteriography was confirmed by phlebography. In another eight renal cysts, a case of haemorrhagic pyelitis and in two cases of unilateral pseudotumerous pyelonephritis, phlebography was of no value.

Adenocarcinoma

Complications of orbital and skull base phlebography.

Two complications, one in association with frontal vein phlebography and one in association with inferior petrosal sinus phlebography, are presented. Possible mechanisms for complications are discussed. It is concluded that a significant risk exists in association with inferior petrosal sinus phlebography, particularly in association with vascular disorders of the skull base, while the risk in association with orbital phlebography after frontal vein puncture is minimal if compression of the jugular veins is omitted.

Aged

[Diagnostic potentials of lympho- and phlebography in tumors of the uterus and adnexa].

103 patients with neoplastic processes in the genitalia have been examined. Lymphography was performed in 73 patients, phlebography - in 52, a combined investigation (lympho- and phlebography) - in 22. Lymphography in malignant uterine and ovarian processes with the involvement of regional lymph nodes provides for direct and indirect signs of metastasization, that allows the stage to be determined with a greater precision and also the roentgenological control over the state of lymph nodes during the conservative therapy. Visceral phlebography gives a definite roentgenological characteristic depending on the site and character of a tumor. An associated use of lympho- and phlebography considerably enlarges the potentialities of these methods for determining the stage and character of tumors and seems to be a valuable adjunct for the differential diagnosis of neoplastic processes of the uterus and adnexa.

Adnexal Diseases

Dynamic radionuclide phlebography. A clinical study in patients after total hip replacement.

Dynamic radionuclide phlebography was performed in 50 consecutive patients after total hip replacement to evaluate the diagnostic value of the method compared to contrast phlebography. The investigation was limited to the diagnosis of iliofemoral thrombi. A special injection technique was developed and flow curves, mean transit time and distribution of flow were recorded with a scintillation camera interfaced to a digital computer. Three principally different types of flow curves were observed. Mean transit time was of value in differentiating particle flow in the superficial veins from passage through the deep veins. Out of 15 legs with thrombi in the iliofemoral region, the distribution of flow was significantly changed in 12. Deep vein thrombosis in the lower leg did not influence mean transit time or distribution of flow in the iliofemora region. Extensive collateral flow was rare. Ninety per cent of the thrombi were asymptomatic. The method compares favorably with the 125 I fibrinogen method and cuff impedance phlebography, in diagnosing iliofemoral thrombi after total hip replacement.

Hip Joint

Relative efficacy of clinical examination, electromyography, plain film radiography, myelography and lumbar phlebography in the diagnosis of low back pain and sciatica.

The procedures used in the investigation of low back pain and sciatica have been subjected to a double statistical analysis to determine their diagnostic accuracy, since contradictory opinions have been expressed in the literature. It was found that only lumbar phlebography was more accurate than the most simple procedure, the clinical examination. Myelography is more accurate than clinical examination only in making a positive diagnosis. In this case, it equals the reliability of lumbar phlebography, but so does plain film radiography which however leads to a positive diagnosis less constantly. Lumbar phlebography is the most accurate procedure for making a negative diagnosis, mainly by avoiding a false negative conclusion. A comparison is made with the statements in the literature and the complementary use of the different procedures is proposed for the investigation of low back pain and sciatica.

Adolescent

Thrombosis after phlebography: a comparison of two contrast media.

In two studies 267 consecutive patients with suspected leg vein thrombosis were examined by an 125I-fibrinogen uptake test (125I-FUT) and by phlebography. The ionic meglumine calcium metrizoate (Isopaque Cerebral) was used as the phlebographic contrast medium in 161 patients, and the non-ionic metrizamide (Amipaque) was used in 106. In these two groups 47 and 41 patients, respectively, had normal phlebograms as well as an initially normal 125I-FUT. After phlebography 29 (62%) of the patients who had received meglumine metrizoate had a significant rise in fibrinogen uptake, while such a rise was not found in patients examined with metrizamide. Repeat phlebography showed fresh deep-vein thrombosis in seven of the nine patients with increased uptake, indicating a complication rate of 48%. Consequently, we now use metrizamide in leg phlebogrphy; because of its expense a radioisotope test is employed as a screening procedure.

Adolescent

Intraoperative internal spermatic vein phlebography in the subfertile male with varicocele.

Intraoperative internal spermatic vein phlebography was performed in 20 subfertile patients with a varicocele; 10 patients with varicoceles and left-sided indirect inguinal hernias without fertility problems served as controls. Phlebography was carried out during surgery with the patient supine and in a 45 degree anti-Trendelenburg position to stimulate an "erect" posture. In all 25 patients with a varicocele, valvular insufficiency was demonstrated at the renal-spermatic vein junction. When visualized, the position of the left adrenal vein in all instances was medial to or opposite the renal-internal spermatic vein confluence. This observation, reinforced by simultaneous determinations of cortisol levels in the internal spermatic and antecubital veins, practically excluded the validity of the theory of adrenal hormonal suppression of testicular tissues. In 40% of subfertile patients with a varicocele, double internal spermatic veins and reflux to the distended external spermatic (cremasteric) venous plexus were demonstrated. In no instance were such phenomena observed in the control groups. The not-infrequent failure of operative correction of varicocele seems to relate directly to such overlooked pathology. Broad clinical application of operative phlebography, especially in recurrent, persistent, or clinically advanced cases, will detect such anomalies and should reduce significantly the operative failures in the surgical correction of varicocele.

Adult

[Occlusion phlebography. Technics and possibilities of use].

The technique and use of occlusion phlebography is described. The method is based on temporary occlusion of blood flow by means of a balloon catheter. Various balloon catheter systems were used and their technical properties were evaluated. The distal veins can be demonstrated by using double lumen catheters, distal and proximal veins by using a catheter with three lumina. Occlusion phlebography is a suitable method for demonstrating hepatic and renal veins; it improves the demonstration of the azygos vein, the suprarenal vein and of visceral pelvic veins, including the iliolumbar veins. It also permits demonstration of the inferior vena cava and parietal veins in the pelvis in separate stages. Occlusion phlebography is the method of choice for the direct demonstration of splenorenal shunts.

Adrenal Glands

Noninvasive diagnosis of acute deep vein thrombosis. A comparison between thermography, plethysmography and phlebography.

Fifty-five patients with clinical signs of acute DVT were investigated with thermography, plethysmography and phlebography. A comparison between phlebography and thermography showed a diagnostic agreement of 84%. Thermography was found, however, to have a low reliability for the localization of acute thrombi and was therefore combined with plethysmography in an attempt to obtain better results in this respect. Compared to the invasive phlebography, the noninvasive combination of thermography and plethysmography adequately located acute DVT in 95% of the cases.

Acute Disease

Orbital phlebography: a comparison between cluster headache and other headaches.

Orbital phlebography has previously been found to be pathologic in 8 of 13 patients with episodic cluster headache. To compare the frequency and pattern of the pathologic findings in cluster headache with those in other headache categories, orbital phlebographies were carried out in patients with cluster headache, cervicogenic headache, migraine and tension-type headache (tension headache). The investigations were evaluated independently by two radiologists, one of whom had no knowledge of the diagnoses. The frequencies of pathologic findings were at maximal 2/12 in the cluster headache group, 2/11 in the cervicogenic headache group, 5/12 in the migraine group and 5/15 in the tension-type headache group. The investigators agreed completely in the evaluation of 39/50 phlebograms, with lesser disagreements in 7. In conclusion, the frequency of pathologic findings at orbital phlebography in cluster headache was not higher than in the other diagnostic categories investigated, and the pattern of the pathology was generally the same.

Adult

Complications of ascending phlebography of the leg.

Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg.

Foot Dermatoses