Treatments & Therapies

Venography – treatment, effect and risks


Venography is a radiological procedure that is used to image the venous system, especially in the veins of the legs. In most cases, the indication arises from the suspicion of thrombosis or varicose veins . Due to the exposure to radiation and contrast media in venography, sonography is increasingly being used as an alternative to visualize veins.

What is venography?

The term venography refers to the procedure of phlebography . This is a diagnostic radiological procedure that displays veins and enables the doctor to assess the venous structures. Phlebographies take place within phlebology and represent one of the meaningful diagnostics for the detection of thrombi.

The procedure of venography is used especially when there is a suspicion of leg vein thrombosis. The visualization of the individual veins is made possible by the injection of X-ray contrast medium, which is usually given into the superficial epifascial veins. With the radiological diagnostic method, functional recordings take place in different time windows, which allow a more detailed assessment of the venous system.

The procedure is rarely used on larger vena cavae in the upper body. As an alternative to venography, sonography can take place, which is used more frequently than radiation-exposed venography, especially in veins of larger caliber.

Function, effect & goals

Leg phlebography is the most common venography. To perform the examination, the standing patient is placed over the ankle area with a constriction, also known as a tourniquet. In order to be able to image the veins, the patient is injected with a contrast medium into a vein on the back of the foot.After the administration of the contrast medium, X-ray images are taken of the leg , which are also known as target images. In the case of arm phlebography, the examiner proceeds analogously to the procedure described. The assessment of the X-ray images is therefore used particularly when thrombosis is suspected, because thrombosis is expressed in the images as contrast medium gaps within the course of the vessels. Thromboses are blockages that can be traced back to blood clots and can be clearly identified using venography.

In the course of the procedure, a so-called phlebogram is created during the venography, which, in addition to indications of thrombosis, can also provide the doctor with signs of varicose veins and even their causes. In most cases, venographic examinations are used within medicine in combination with other examination procedures, for example as a complement to or as a supplement to them. Venography is sometimes combined most frequently with duplex sonography, especially in the case of unsuccessful duplex sonography. Although veins can now be imaged using less stressful methods, venography still has its advantages , especially in branched and thin veins of the lower leg or forearm.

The procedure also offers advantages in the case of more complex varicose veins or in patients with postthrombotic syndrome. The method is also advantageous over other procedures for depicting venous valves. Since venography is still associated with the most reliable statements, it is often used for varicose vein operations and their preparation. Only in rare cases is a phlebography performed on the large vena cava in the upper body. The same applies to the abdominal area. The technique used is similar to that just described, but usually requires larger amounts of contrast medium and higher flow rates.

This modification of the procedure is often referred to as an upper or lower cavography. However, this variant of venography has now been almost completely replaced by computed tomography and magnetic resonance imaging , since both methods provide significantly more additional information on approximately the same burdens on the organism. The greatest advantage of phlebography is the complete representation of branched or complex venous systems, which can be done over a longer distance. In addition, venography enables visual documentation of functional peculiarities, such as those that can arise during movements of the extremities or a change in position in the venous system.

Risks, side effects & dangers

As a radiological procedure, venography is associated with some risks and side effects. This includes, for example, the radiation exposure to which the patients have to be exposed during the procedure. In the meantime, this burden is extremely low and only in the rarest of cases has actual consequences.The contrast medium injection, which can cause allergies , poses a slightly higher risk . The most common side effects of contrast media are headaches and nausea. After the contrast medium has been administered, the patient is asked to drink a lot of liquid on the same day and in this way flush out the medium as quickly as possible. If contrast agent stays in the body for too long, it puts a strain on the kidneys in particular. Venography also has some disadvantages for the institution performing the procedure, above all the expensive and site-specific equipment and the need for radiologically experienced specialists. For this reason, modern alternatives are often given precedence in the assessment of veins, such as sonography.

Thrombosis can be ruled out or confirmed using the less stressful procedure. MRI is also often used for large caliber veins, although this is similarly stressful for the patient. Duplex color Doppler sonography is now used most frequently for all other veins, since this method does not involve exposure to radiation or contrast media for the patient. While sonographic procedures can usually be performed on an outpatient basis, procedures such as MRI, CT or venography often require the patient to be admitted to the hospital.

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.