Direct Phlebography for Visualization of the Deep Veins in the Lower Extremities

Abstract

A new method of phlebography, which the authors have named "direct phlebography," was developed as a means of obtaining accurate information on the deep vein system, as well as on the communicating veins in the lower extremities. This method consists of two techniques: one is a retrograde insertion of a catheter into the deep veins and the other is a direct injection of the contrast medium into the deep veins. For these techniques, use of a thin, soft guidewire and catheter; injection of a low-osmolar contrast medium; and systemic administration of heparin are important. In cases of varix cruris, the deep veins and the insufficient communicating veins were clearly visualized by this method. In cases of deep vein thrombosis, a "narrowed" but patent common or superficial femoral vein was detected, which had often been diagnosed as "occluded" by conventional ascending phlebography. The deep femoral vein was usually patent. The authors have used this method in 54 limbs, but no serious complications such as venous valve injury, severe extravasation, or thrombus formation have been encountered so far, except for a small extravasation in 1 patient with superficial femoral vein thrombosis. This new method, used to visualize the deep vein system directly, is thought to provide correct and useful information about the lesions in the deep vein system of the lower extremities.