Phlebography: Treatment, Effects & Risks

Phlebography is a radiological examination method. It is used to evaluate the veins.

What is phlebography?

Phlebography is a radiological examination method. It is used to evaluate the veins. Phlebography or phlebography is a subsection of angiography. It is one of the imaging examination methods. A contrast medium containing iodine is used, which is injected by the physician into the vein region to be examined. At the same time, the physician performs an X-ray examination to record the flow of the contrast medium. Phlebography is used for imaging shoulder-arm veins, leg-conducting veins and pelvic veins. Only in rare cases is it performed as a first-line procedure. It is often performed after a sonography (ultrasound examination). It is helpful in clarifying imprecise findings in cases of suspected blood clots (thrombosis). Thus, thromboses in the veins of the thigh as well as in the veins of the lower leg can be clarified particularly well with phlebography.

Function, effect, and goals

The areas of application for phlebography primarily include varicose veins (varicoses), venous thrombosis (phlebothrombosis), postthrombotic syndrome, and recurrent varicoses, in which varicose veins form again. In addition, phlebography is performed after unclear ultrasound examinations, if a life-threatening pulmonary embolism is suspected, which is often caused by a displaced leg vein thrombosis, before the performance of a surgical thrombectomy or a drug thrombolysis, as well as to monitor the further course after a pronounced phlebothrombosis. Similarly, inflammations or tumors that appear in the vein area can be detected through the use of phlebography. Before phlebography can take place, the patient must first be injected with a contrast medium into the vein in question. The blood in the veins has the property of flowing toward the heart. In this way, a good distribution of the contrast agent is possible. The special X-ray examination allows the internal vein structure to be precisely visualized. This gives the physician the opportunity to identify any changes, which include obstructions or constrictions. Before a phlebography is performed, the patient must inform the doctor if he or she suffers from certain allergies. About four hours before the examination begins, the patient must not eat anything. In some cases, it may also be useful to perform a foot bath to soften the skin and dilate the veins. This, in turn, allows for better venous access to be created. If phlebography is performed on the leg, which is usually the case, the patient lies down on a couch. In doing so, the feet tilt in the downward direction. A tourniquet is placed over the ankle so that the contrast medium can also reach the deep veins of the leg. The contrast agent is then injected into a vein in the dorsum of the foot. Through the vein, the agent can penetrate into the deeper parts of the body. The next step is to take X-rays. The doctor looks at the pelvis, thigh, knee and lower leg. The radiographs are taken from several directions. The leg is rotated in the inner and outer direction. If a thrombosis is present, this can be seen on the image as a filling defect, which is sharply defined. When checking the function of the venous valves, the patient must push in a similar way to defecation. In this way, the physician can determine whether the venous blood is returning and whether the tightness of the venous valves exists. In total, phlebography takes only 5 to 10 minutes. At the end of the examination, the leg is wrapped tightly. However, a support stocking can also be put on. To better remove the contrast medium, the patient should move around for about 30 minutes. The excretion of the agent takes place via the kidneys. The patient must therefore drink plenty of fluids. If phlebography alone is not sufficient for diagnosis, there is also the option of CT phlebography, in which the veins are examined by computer tomography, or magnetic resonance phlebography, which can be performed with or without contrast medium.

Risks, side effects and dangers

When performing phlebography, some side effects are within the realm of possibility. These include bleeding at the puncture site, for example. Some patients also suffer from infection or scarring. Furthermore, the contrast medium may irritate the walls of the veins or cause allergic reactions. If a thrombosis is present, it is possible that a blood clot could break loose and travel to other parts of the body in this way. If the physician inserts a catheter, there is a risk that the vein wall will be punctured by the instrument or needle. In addition to risks and side effects, there are also some contraindications to consider. First and foremost, these include a possible intolerance of the patient to the contrast agent. Other contraindications include chronic lymphatic congestion, acute inflammation in the shoulder-arm region, foot or lower leg, and hyperthyroidism. For these reasons, before phlebography is performed, the patient must be informed by the physician in detail about the risks and side effects of the procedure, which includes X-ray exposure. Sometimes other procedures that are non-invasive may be more useful for the examination. Phlebography has both advantages and disadvantages. Its greatest advantage is complete visualization of the venous vasculature. Functional features are easily seen on the radiograph. However, the radiation exposure is considered a minus point. In addition, the contrast medium causes stress on the kidneys. Furthermore, the radiological equipment technology is associated with a higher cost.