Phlebography

What does the phlebography examination include?

Phlebography: the evolution of the method and its place in modern phlebology

Phlebography, introduced in the 1960s, revolutionised the diagnosis of venous disease. For decades, it was the 'gold standard' in lower limb venous imaging. Classical ascending phlebography, consisted of injecting an iodine contrast agent into the veins of the foot and following its spread.
In the 1990s Doppler ultrasound examination - dynamically developed at the time - began to gradually supplant and replace ascending phlebography as the primary diagnostic tool in lower limb venous disorders. This process took about a decade and was closely linked to the technological development of ultrasonography.

The diagnosis of abdominal and pelvic veins has similarly evolved. Formerly used routinely retrograde phlebographywith which the anatomy of the venous system, its morphology and abnormalities could be visualised, has been replaced at the diagnostic stage by increasingly better ultrasound systems and venographic imaging based on magnetic resonance (MR) and computed tomography (CT) techniques. Modern digital phlebography Instead, it has found its place as an indispensable tool during intravenous procedures. During these procedures, real-time imaging is crucial for the precise performance of the procedure. Thanks to state-of-the-art systems such as the Philips Zenition 70, using planar detectors and advanced image processing algorithms, it is possible to achieve high-quality imaging with a significantly reduced radiation dose compared to classic phlebography (see phlebography images above).

Contemporary indications for digital phlebography

Phlebography is mainly performed intraoperatively in the following cases:

• in the diagnosis of venous compression phenomena and venous trunk entrapment syndromes;
• in the assessment of the spinal or retroperitoneal circulation;
• in the diagnosis of pelvic venous insufficiency;
• in the assessment of complex vascular malformations;
• In assessing the patency of large venous vessels (inferior vena cava, iliac veins;
• in planning the treatment of post-thrombotic lesions in proximal vessels;
• generally in the verification of diagnostically unclear situations to verify indications for intravenous procedures.

How to prepare for a phlebography examination?

As phlebography is an examination performed with a contrast agent and is usually part of an intravenous procedure on the venous system, the preparation is similar to procedures and typical contrast diagnostic examinations. Before digital phlebography is performed, you should:

• up to 5-7 days before phlebography, determine basic blood parameters such as blood count, coagulation system and, most importantly, creatinine levels and TSH (thyroid hormone) levels;
• for women: perform a home pregnancy test 2-3 days before the test and send confirmation of the result;
• inform your doctor 5-7 days in advance of all medications you are taking, especially anticoagulants (anticoagulants), aspirin and other medications that affect blood clotting;
• remain fasting for a minimum of 4-6 hours before the test;
• bring previous medical records with you;
• inform the doctor on the day of the examination of any allergies and sensitivities, especially to contrast agents, iodine, drugs, latex or anaesthetics;
• remove jewellery and other metal objects from the examination area on the day of the examination.

How does phlebography work?

In the Department of Phlebology digital phlebography is performed in an operating theatre setting by an experienced team of specialists: a phlebologist and an interventional radiologist. Percutaneous access to the venous vessel - necessary for phlebography - is inserted under local anaesthesia under ultrasound guidance. If phlebography is only part of the surgical procedure, it is usually performed using shallow sedation under the control of the anaesthetic team. Once the contrast agent is injected into the venous system, a series of X-rays in various projections are taken, allowing for a thorough assessment of the anatomy and function of the venous vessels. The examination itself and the administration of small doses of diluted contrast medium are not perceptible to the patient.
The duration of the examination is usually 20-30 minutes. After phlebography, the patient remains under observation by medical staff for approximately 30-60 minutes. After the examination, it is advisable to drink plenty of fluids (2-3 litres of still water) to stimulate the kidneys and flush out the contrast agent administered. avoid dehydration.

What sets us apart?

At the Phlebology Clinic we offer and use:

• Philips' state-of-the-art, low-dose diagnostic equipment called Zenition 70;
• a proprietary diagnostic pathway based on more than 10 years of experience in the causal treatment of venous disease;
• A comprehensive approach to the diagnosis and treatment of venous disease;
• a team of experienced specialists in radiology, interventional radiology, phlebology and vascular surgery;
• effectiveness confirmed by scientific studies.