Babeh Edi

Venography Basic Venogram

Indications for imaging Deep vein thrombosis Lower limb oedema of the lower limb of unknown origin Investigation of congenital venous abnormalities Demonstration of incompetent perforating veins Anatomy  Demonstrated Venous anatomy of the lower limbs (Ross & Wilson Foundations of A&P) Technique In order to reduce any oedema of the lower limb the patient should rest with the limb elevated for 8 hours before the examination Normal contrast media preparation and precautions are taken. The patient lies on a general fluoroscopy couch The couch is tilted feet down approximately 30 degrees to delay contrast media travel and help dilate the lower veins. A tourniquet is applied just above the ankle. A vein on the foot is cannulated using the largest bore needle compatible with vein size, typically a 19 or 21 gauge. Up to 40 ml of contrast media is injected and a series of spot films are taken from the foot to the pelvis, a typical series is AP and both oblique from foot to ankle then PA films from knee to the pelvis. Some centres repeat the series with the patient performing the Va salver manoeuvre and head down 15 degrees. A final film of the renal area may be taken in some centres.   Contrast media Non ionic iodinated contrast agent of strength approx 200 e.g. Niopam 200 Note contra indications for diabetic patients on metformin.   Radiation protection General  fluoroscopic dose limiting precautions should be employed.   Equipment   +/- Tilting fluoroscopy table with spot film device Tourniquet Injection tray   Complications Thrombophlebits Contrast media extravasation Cardia arrhythmias in patients with pulmonary hypertension General contrast media complications Haematoma at injection site Pulmonary embolus   Aftercare The injection site should be dressed and checked for leakage then a dressing applied The patient should exercise the limb or physiotherapy may be required in the non ambulant patient. Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette General low Kv fluoroscopic values Additional modalities Ultrasound has superseded Venography in many centres.   Images   Ref: A guide to radiological Procedures by Chapman & Nakielny 2 nd Edition