Treatments & Therapies

Phlebography – Treatment, Effect & Risks


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

What is phlebography?

Phlebography or phlebography is a sub-area of ​​angiography . It is one of the imaging examination methods. A contrast medium containing iodine is used, which is injected by the doctor into the vein region to be examined. At the same time, the doctor performs an X-ray examination to record the flow of the contrast medium.

Phlebography is used to visualize shoulder-arm veins, leg veins and pelvic veins. Only in rare cases is it implemented as the first choice. It is often only carried out after a sonography (ultrasound examination). It is helpful to clarify imprecise findings when a blood clot (thrombosis) is suspected. Thromboses in the veins of the thigh and in the lower leg veins can be clarified particularly well with phlebography.

Function, effect & goals

The areas of application for phlebography primarily include varicose veins (varicose veins), venous thrombosis (phlebothrombosis), postthrombotic syndrome and recurrent varicose veins, in which varicose veins form again .

In addition, phlebography is carried out after unclear ultrasound examinations, if a life-threatening pulmonary embolism is suspected , which is often caused by a delayed venous thrombosis in the leg, before an operative thrombectomy or drug thrombolysis is carried out, and to monitor the further course after a pronounced phlebothrombosis. Inflammations or tumors that appear in the vein area can also be detected by using phlebography.

Before the phlebography can take place, the patient must first be injected with a contrast medium into the vein in question. The blood in the veins tends to flow toward the heart . In this way, a good distribution of the contrast agent is possible. The internal vein structure can be precisely displayed using the special X-ray examination. The doctor thus has the opportunity to determine any changes, which include transfers or bottlenecks.

Before conducting venography, the patient must inform the doctor whether he suffers from certain allergies . About four hours before the examination begins, the patient is not allowed to eat anything. In some cases, a foot bath can also be useful to soften the skin and dilate the veins. This in turn allows for better vein access.

If phlebography is performed on the leg, which is usually the case, the patient lies down on a couch. The feet incline in the lower direction. A tourniquet is placed over the ankle so that the contrast agent can also get into the deep veins of the leg. The contrast medium is then injected into a vein on the back of the foot. Through the vein, the drug can penetrate into the deeper parts of the body. The next step is to take the X-rays. The doctor looks at the pelvis, the thigh, the knee and the lower leg . The X-ray images are taken from several directions. The leg rotates inward and outward.

If there is a thrombosis, this can be seen on the image as a filling defect that is sharply demarcated. When checking the function of the venous valves, the patient has to strain in a similar way to when having a bowel movement. In this way, the doctor can determine whether the venous blood is returning and whether the venous valves are tight. Overall, the phlebography only takes 5 to 10 minutes.

After the end of the examination, the leg is wrapped tightly. A support stocking can also be worn. In order to better transport the contrast medium, the patient should move for about 30 minutes. The elimination of the drug 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 using computer tomography, or magnetic resonance phlebography, which can be performed with or without a contrast medium.

Risks, side effects & dangers

When performing phlebography, some side effects are possible. This includes, for example, bleeding at the puncture site. Some patients also suffer from infections or scarring. The contrast medium can also irritate the walls of the veins or cause allergic reactions.

If there is a thrombosis , it is possible for a blood clot to break free and in this way penetrate to other parts of the body. If the doctor 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. This primarily includes a possible intolerance of the patient to the contrast agent. Further contraindications are chronic lymphatic congestion, acute inflammation in the shoulder-arm region, on the foot or lower leg, and an overactive thyroid gland . For these reasons, before performing phlebography, the patient must be informed by the doctor in detail about the risks and side effects of the procedure, which also includes exposure to X-rays. Sometimes other procedures that are not invasive may be more useful for the examination.

Phlebography has both advantages and disadvantages. Its greatest advantage is the complete representation of the venous vascular system. Functional features are clearly visible on the X-ray. The downside, however, is the exposure to radiation. In addition, the contrast medium puts a strain on the kidneys . Furthermore, the radiological equipment technology is associated with higher costs.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.