DeWeese, James A.; Rogoff, Stanley M.
October 1958
Angiology;Oct1958, Vol. 9 Issue 5, p268
Academic Journal
Functional ascending phlebography has been performed on 69 extremities of 54 patients for the evaluation of the deep veins of the lower extremity. 1. Phlebography has been helpful in determining whether or not there was acute venous thrombosis in the lower extremities of 10 of 13 patients who had either equivocal clinical signs of thrombosis or pulmonary emboli from an undetermined source. A definite phlebographic diagnosis of thrombosis about be made only if the defect has sharp margins in a heavily opacified vein, and is seen on two radiographs. 2. Phlebograms were obtained on 8 patients with acute iliofemoral venous thrombosis and/ or after thrombectomy. The phlebograms indicate that iliofemoral venous thrombosis probably originated in the iliac or femoral vein, rather than in the lower leg. Postoperative phlebograms offer an objective method for the evaluation of thrombectomy as a therapeutic procedure. 3. On 8 patients ten extremities with suggestive but not clear cut histories of previous deep vein thrombosis have been examined, with demonstrable evidence of previous disease in one extremity. The negative results were of equal value in the management of the patients. 4. Seventeen extremities of patients with complicated varicose problems but without historical evidence for previous deep venous thrombosis were examined. Valveless and/or abnormal dilated femoral veins were demonstrated in 8 of the extremities. These changes were unlike those noted in post-phlebitic extremities. The failure of communicators, collaterals and deep veins of the calf to empty after exercise was related to the presence of these abnormal femoral veins. The significance of those abnormal thigh veins and their contribution to venous stasis has been discussed. 5. Phlebograms were obtained on 13 extremities of 11 patients with histories of chronic leg swelling for which there was more than one possible cause. As a result of the examination negative phlebograms strengthened the diagnosis of lymphedema in 6 patients. Deep vein pathology was also ruled out in 2 other patients. The diagnosis of old deep venous thrombosis was established in 2 other patients. 6. The method proved to be a relatively simple and practical method for the evaluation of these groups of patients. No known venous thrombosis has followed the procedure.


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