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Why venography period? Let alone one in the foot, then one in the femoral?
Brian Sadauskas
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Nix, Lee wrote:

> Ann Marie:
>   I have had the same experience.  We identified proximal femoral vein
> thrombosis by duplex.  It was not seen on venography when the contrast was
> injected in a foot vein.  Repeat venography with a femoral injection
> identified the thrombus.  For this reason our interventional radiologists
> will do a femoral injection in such instances. especially if we let them
> know that the rest of the limb was normal.
>    My understanding is that in venograms utilizing a foot vein for injection
> of contrast there is significant dilution of contrast in the femoral and
> iliac veins.  In addition, Rabinov says in his chanpter "venography of the
> Lower Extremities" in Abrams Angiography   "...fluoroscopic mode for further
> evaluation of the upper femoral and iliac veins, in which flow defects are
> common at the sites of large-vein confluence."  My understanding is that it
> can be very difficult to differentiate thrombus from flow defects at that
> level.
> M. Lee Nix, B.S.N., R.N., R.V.T.
> Director, Vascular Lab
> Instructor, Deparment of Surgery
> University of Arkansas for Medical Sciences
> [log in to unmask]
> 501  686-5318
>
> > -----Original Message-----
> > From: Ann Marie Kupinski [SMTP:[log in to unmask]]
> > Sent: Friday, December 18, 1998 4:32 PM
> > To:   [log in to unmask]
> > Subject:      Venography
> >
> >      I am in the middle of a "discussion" with an interventional
> >      radiologist concerning venography.  The discussion centers around a
> >      patient who had a non-occluding DVT in the external iliac vein, a
> >      short distance above the sapheno-femoral junction.  This DVT was
> >      clearly demonstrated on duplex ultrasound but failed to show up on a
> >      venogram.  I was told that multiple views were used to look for this
> >      clot but nothing was revealed.  Does anyone have any info on false
> >      negative venograms?  I plan to look through the literature but I
> >      thought I would check with folks on the flownet first.  Two days
> > after
> >      the initial duplex, an additional scan demonstrated thrombus at the
> >      sapheno-femoral junction that was confirmed by a Radiologist.  At
> > this
> >      point the patient received a filter.  Prior to this scan, no therapy
> >      was performed since the gold standard venogram was felt to be correct
> >      and the duplex incorrect.
> >
> >      Any help would be appreciated!  Thanks and happy holidays!
> >
> >      Ann Marie Kupinski