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X-ray contrast venography. What is phlebography of the veins of the lower extremities. Indications for examination

Phlebography of the lower extremities is a method of studying the condition of the walls of blood vessels, allowing to identify various venous pathologies, such as varicose veins, thrombophlebitis, and vascular insufficiency.

The peculiarity of the method is that it is the result of the interaction of X-rays and a substance - contrast, introduced directly into the vessel.

Popular X-ray analysis only determines the presence of neoplasms: tumors, bone growths, structural changes, but does not provide the ability to visualize veins.

But doctors invented a method based on the contrast of the substance introduced into the vessel and X-ray rays, thanks to which a complete display of the condition, structure and shape of the venous wall became possible and harmless. This diagnostic method is called radiopaque venography.

Essence of the method

This diagnostic technique has been carried out since the beginning of the last century and remains a privileged angiological procedure to this day.

The method is an analysis that is carried out by introducing into the veins a contrast composition that transmits x-rays, allowing one to identify all the features of the condition of the vascular wall.

The X-ray contrast agent is created in such a way that its breakdown products leave the body as quickly as possible. a short time after venography.

Varieties of techniques

Radiography can be performed in an ascending and retrograde manner.

Rising

It is performed with the patient lying on the table. A catheter is inserted into the venous vessel of the foot, then the saphenous veins are clamped using a rubber band.

If necessary, novocaine can be injected into the vessel to avoid angiological spasm.

Then the table is installed in a vertical position, and the patient is injected with a contrast solution to fill the venous vessels of various locations. As the deep veins fill, images are taken, after which the patient is released from the tourniquets.

To avoid infiltrates and thrombosis, the patient is recommended to take an active walk or physical exercise, to restore blood flow speed.

Retrograde

The contrast agent enters directly into the vessel to be examined to diagnose the condition of its valve system. After the procedure, the reagent gradually flows towards the foot. This method is carried out in case of obvious venous pathologies, when the outflow of blood upward is difficult.

The duration of the study can be from 30 to 60 minutes. There are no painful sensations in this case. Pain can only appear when a vein is punctured when a catheter is installed, and a feeling of nausea occurs when a substance - a reagent - enters the body.

"Pros and cons"

Contrast venography of the lower extremities has a number of undeniable advantages:

  • It is carried out in almost any specialized clinic.
  • This method causes almost no discomfort.
  • Thanks to phlebography, it is possible to accurately determine the condition of blood vessels, the error is less than 5%, in contrast to the ultrasound method.
  • Despite the fact that this method is invasive, the intervention in the body during its implementation is minimal, and the morbidity is quite low.

However, there are also disadvantages. Before performing phlebography of veins, the patient should familiarize himself with this information:

  1. Invasive nature. In order for the contrast solution to get inside the vessel, it is necessary to puncture the vein and insert a catheter. Damage to the vein carries the risk of infection, hematoma, infiltration, and in rare cases, blood clots.
  2. Overcharge. For an analysis such as phlebography, the patient will have to pay about fifteen thousand rubles for one leg, while obtaining phlebological data using an ultrasound method will cost 10 times less.
  3. The threat of allergies, toxic shock, inflammation in the walls of veins and soft tissues associated with the body’s reaction to the iodine contained in the contrast solution.
  4. Irradiation.

Phlebography of the lower extremities, the price of which is quite high, is necessary in the presence of varicose veins and CVI, in order to identify dangerous symptoms of these diseases, as well as in other cases:

  • Diagnosis of valvular dysfunctions of superficial and deep venous vessels.
  • Detection of wandering blood clots.
  • Postphlebitic syndrome is also an indication.
  • If necessary, coronary artery bypass grafting.
  • In case of abnormal development of venous vessels of a congenital nature.
  • For valvular dysfunction and retrograde blood flow, to determine the location and size of blood clots.
  • The procedure is also carried out before installing the so-called “clot trap”, or vena cava filter. This device is a metal part that is installed in the inferior vena cava to “catch” blood clots in order to prevent pulmonary embolism.

Phlebography is not performed if there is a history of intractable diseases such as:

  1. Thyrotoxicosis is an excess of thyroid hormones.
  2. Serious disruptions in the functioning of the liver and kidneys, in the chronic and acute stages.
  3. Tuberculosis in a severe stage of development.
  4. Pathological mental disorders.
  5. Individual intolerance to the iodine component.
  6. Venous gangrene.
  7. The patient is in a serious condition that precludes any surgical procedures.
  8. State of pregnancy.

Preparatory measures

Preparing for the venography procedure does not present any serious difficulties, but some measures should still be taken.

  • The patient must refrain from eating 4-5 hours before the test to avoid nausea and vomiting. Ideally, it is not recommended to eat the entire day before the procedure, with the exception of a morning glass of water.
  • If it is necessary to examine deep venous vessels - for example, the inferior vena cava - it is necessary to perform a cleansing enema in order to completely empty the intestinal tract.
  • Before the procedure, it is recommended to measure the patient’s pulse; if it increases, take sedatives.

Completing diagnostics

After the study is completed, the tourniquet is removed, and a little saline solution is injected into the vein.

As for allergies, this reaction may appear as early as half an hour after the procedure. During this time, the patient should be under the supervision of a doctor.

In conclusion, in order for the contrast substance to leave the patient’s body as quickly as possible, he is recommended to drink plenty of fluids.

Non-contrast magnetic resonance venography of the inferior vena cava (IVC) is the optimal method for examining the veins of the IVC basin from the level of the ligament to the diaphragm. Diagnostics allows you to clearly visualize vascular structures, detect anomalies and the most minor changes in tissues. The method does not require the use of a contrast agent and does not provide radiation exposure, so this examination is absolutely safe.

At Ramsey Diagnostics centers, you can perform MRI of the inferior vena cava.

When is it appointed?

  • deep vein thrombosis
  • presence of embolus
  • various types of congenital and acquired vascular anomalies
  • check the functionality of the venous valves, analyze their patency, lumen and filling nature

What does non-contrast MR venography of the inferior vena cava determine?

Using this method, you can effectively diagnose the following pathologies and diseases:

  • intravasal (intravascular) disorders in the form of thrombosis and postthrombotic changes in blood vessels
  • May-Turner syndrome
  • degenerative changes at the level of the lumbosacral spine
  • volumetric formations

Advantage over CT

The great advantage of magnetic resonance phlebography compared to radiopaque or CT angiography is the elimination of exposure to x-rays on the body. Another advantage is high information content and the ability to visualize vessels without the use of a contrast agent. The patient does not require special preparation for the study; diagnostics can be performed on an outpatient basis, and the procedure takes only 15 minutes.

The examination is carried out on a modern international class tomograph Optima MR360 Advance manufactured by General Electric (USA).

The standard limitation is the presence of metal grafts in the body, as well as other factors. You can find out more about them on the website in the section General contraindications for MRI.

In addition to MR venography, Ramsey Diagnostics centers provide the opportunity to do

Contrast venography (venography, ascending contrast venography or contrast venography) is X-ray examination deep or superficial veins using a contrast agent that provides an image of the blood vessel. Phlebography determines the patency of the deep veins, the presence of blood clots, valve function and allows for a general assessment of the condition of the deep veins.

Phlebography can be used when deep vein thrombosis is suspected, but ultrasound diagnostics cannot accurately exclude it.
The study allows us to reliably assess the condition of the iliac veins in obese patients, when it is impossible to conduct a detailed ultrasound scan.

Contrast venography is most often used either during endovascular surgery on the deep veins (angioplasty or installation of a vena cava filter). We use retrograde venography to assess the integrity of venous valves when planning surgery for venous outflow reflux after venous thrombosis.

Contrast venography at the Innovative Vascular Center

Phlebography is the main method for diagnosing the condition of veins during vascular surgery. To determine indications for intervention, we often use minimally invasive technologies, such as MSCT or MRI of veins. In our clinic, venography is also used to assess the function of deep vein valves in post-thrombotic disease. Based on these data, we plan intervention on the deep veins.

Contraindications

  • Severe renal failure, since the contrast can have a negative effect on the kidneys.
  • Pregnant women, because exposure to ionizing radiation may harm the fetus.
  • People with an allergy to iodine may have an allergic reaction to iodine-based contrast dyes.

Preparation

  • You cannot eat for four hours before the test, and you can only drink water.
  • Patients who are allergic (particularly to iodine) or have already had a reaction to contrast should inform their doctor.
  • A sedative may be prescribed to calm the patient.
  • You may be asked to follow certain dietary restrictions before the test, depending on your specific procedure.
  • Tell your doctor about the medications, herbs, or supplements you take. You may be advised to stop taking some of these medications before the test.

How is the diagnosis carried out?

During the procedure, the patient lies on a special X-ray table. The area where the catheter will be inserted is cleared (usually a vein in the arm so that any necessary medications can be administered during the procedure). Sometimes local anesthesia is administered.

A contrast solution is delivered through the catheter. The dye injection causes a warm sensation that can spread throughout the body. The contrast may also cause mild nausea. About 18% of patients experience discomfort from the contrast solution. To fill the deep venous system with dye, a thick tape (or tourniquet) is sometimes placed around the ankle, or the limbs may be angled. The patient is asked to keep his leg still. The doctor watches the movement of the solution through the vein using a fluoroscope. At the same time, a series of photographs are taken.

When the study is completed, saline is injected into the same catheter to clear the veins of contrast, then the catheter is removed and a bandage is applied to the injection site.

Features of phlebography (according to the location of the veins being examined):

Venography of the lower limb: The patient is positioned leaning on an inclined X-ray table. The table is tilted so that the legs are raised or lowered. The catheter is inserted into the selected leg or arm. The procedure may take 30 to 45 minutes.

Adrenal phlebography: the patient lies on his back on the x-ray table. The catheter is inserted into the femoral vein. Under the guidance of fluoroscopic visualization, he carefully targets either the renal or suprarenal veins in abdominal cavity. The procedure takes about 1 hour.

Abdominal phlebography: the patient lies on his back on the x-ray table. The catheter is inserted into the femoral artery. The procedure takes about 1 hour.

After diagnosis

After phlebography, observation in the clinic is necessary for at least 24 hours. Depending on the procedure, you may be advised to rest in bed for a certain period of time.

Patients should drink plenty of fluids to flush any remaining contrast solution from the body.
The area where the catheter was inserted may be sore for several days. If you notice swelling, redness, pain, or fever, tell your doctor. In most cases, the patient can resume normal activities the next day.

Possible complications

Phlebography can cause complications such as phlebitis, tissue damage, and deep vein thrombosis in the healthy leg. Complications are quite rare, but they must be taken into account when planning treatment so that the risk of the study does not exceed the risk of the disease for which it is being performed.

A rare side effect (up to 1% of cases) is a serious allergic reaction to the contrast dye. It usually appears 30 minutes after the dye injection and requires medical attention.

Possible risks include blood clot formation in the vein, bleeding, damage to blood vessels, or infection at the site where the catheter was inserted.

Some people may experience an allergic reaction to iodine-based contrast dye. This can cause symptoms such as nausea, sneezing, vomiting, hives, and sometimes a life-threatening reaction called anaphylactic shock (especially in older patients with chronic dehydration or mild kidney failure).

The method is also used for differential diagnosis diseases.

Phlebography of veins can be ascending and retrograde. The first is carried out in a horizontal position of the patient and checks the occupancy of the vascular bed, the second - using the Valsalva maneuver and allows you to check the full functioning of the valves.

Phlebography of the lower extremities

Venography of the vessels of the legs allows you to identify the presence of blood clots in the walls of blood vessels, developmental anomalies, check the usefulness of the venous valves, and the patency of the vessels.

By visualizing the image, the doctor receives a complete picture of the structure and location of the vessels.

This makes it possible to use the method in cases where other instrumental studies turned out to be insufficiently informative.

When is it carried out?

Phlebography of leg vessels is prescribed for the following pathologies:

  1. Varicose veins and its relapses.
  2. For the purpose of introducing medicines into the lumen of the vessel (for example, during sclerotherapy).
  3. In the presence of postthrombophlebitis syndrome.

Preparation

Preparation for the procedure is simple. To begin with, it is important to obtain written consent from the patient. The patient himself is prohibited from eating 4-5 hours before the test. Liquids can be consumed, but only water.

Immediately before the test, the patient empties the bladder. The procedure itself can cause some discomfort, so pain relief is sometimes performed by administering analgesics.

Progress of the procedure

The patient lies down on the couch, movement is prohibited, and a tourniquet is applied to the ankle of the limb being examined to improve blood flow. A puncture of the superficial vein of the foot is performed, first a saline solution is injected, then a contrast agent is injected very slowly.

On the monitor screen of the X-ray machine, the doctor observes the spread of contrast, photographs are taken, and if the result is positive, the limb is quickly raised upward to remove the substance.

After it is completely removed, the needle is removed and a sterile bandage is applied to the puncture site.

The duration of the procedure is no more than 2 minutes, during which the doctor can take up to 9-10 pictures.

Phlebography of the lower extremities can lead to complications - thrombophlebitis, abscesses in the puncture area, phlegmon, inflammation. Such cases are quite rare, but caution must be exercised as there is still a risk.

Phlebography of the brain

The method is used to assess venous circulation and its disorders in the vascular system of the brain. The essence of the method is to obtain a contrast image between static tissues and fluid flow.

Venography of cerebral vessels can be two- and three-dimensional and allows you to assess the condition of the walls of blood vessels, their patency, and the functionality of the venous sinuses.

When is it carried out?

Used for the following patient complaints:

  1. Headaches of unknown origin and dizziness.
  2. Confusion of consciousness along with drowsiness and fatigue.
  3. Suspicions of tumor processes of vascular origin (for example, venous sinus of the dura mater).

There are quite a few indications, so you need to have an idea of ​​what MRI venography of the brain is.

Preparation

Venography, like all interventions, begins with obtaining the patient's consent. Afterwards, the patient must remove all jewelry, remove keys, money, wallet, hair accessories, hearing aids, and magnetic plastic cards.

Progress of the procedure

The patient takes a supine position, the head is fixed, a cushion is placed under the legs.

After which the patient is moved into the chamber for the procedure, during which photographs are taken in various sections and planes.

The resulting images form the most complete picture of the condition vascular system, help confirm or refute the presence of pathology.

Phlebography of the pelvic veins

Women may experience this after pregnancy. The affected vessels are localized mainly in the ovarian region and can lead to complications such as thrombophlebitis or bleeding.

When is it carried out?

Transuterine venography is used to confirm the diagnosis. The study provides information about the permeability of fluid in the venous lumen, the operation of valves, the rate of release of the contrast agent, and the presence of blood clots on the walls of blood vessels.

It is worth noting that in gynecological practice, pelvic phlebography is not the main research method; it is used as an additional method to clarify the diagnosis.

Preparation

Venography is performed on an empty stomach; a light dinner is acceptable the day before. You can drink liquid on the day of the test.

Progress of the procedure

The procedure begins with the introduction of gynecological speculum, then a soft conductor is inserted into the organ cavity (to prevent perforation) and moves to the fundus of the uterus. Afterwards, a catheter with a needle is inserted, the wall is pierced, and a contrast agent is injected. After half a minute you can take pictures.

The duration of the procedure is on average less than half an hour.

Phlebography for varicocele

Varicocele is an expansion of the venous vessels of the spermatic cord, usually on the left side. The pathology is quite common. The reasons may be compression of the left renal vein, varicose veins of the scrotum, sometimes portal hypertension or tumor diseases of these vessels.

The study is carried out for diagnostic purposes to determine the tactics of surgical intervention.

Preparation

Surgical and diagnostic intervention does not require special preparation; it is necessary to carry out hygienic treatment of the access area; 12 hours before surgery you should not consume food or liquid.

Progress of the procedure

There is a method of venography with a puncture in the scrotum area, installation of a catheter and administration of a contrast agent into the lumen of the vessel. This type of procedure is quite traumatic, can cause complications and is also expensive. The specialist will also receive information about the diameter of the vessel, but will not be able to judge the state of blood circulation.

There is a venography method that uses catheterization and contrast of the renal vessels.

The study is carried out using the Valsalva maneuver - exhalation of air with the nose and mouth closed.

Phlebography allows one to judge the nature of blood flow and its synchronization with respiratory movements, but does not provide information about the complete structure of the vascular bed.

The most convenient method of performing phlebography for varicocele is the following. First, puncture and catheterization of the peripheral vessel is performed.

Afterwards, a catheter is inserted into the left renal and internal spermatic vein. They are also contrasted when the patient performs a forced exhalation of air.

The substance is carried out through all venous vessels, making it possible to record the presence of reflux, as well as diameter and compression. Afterwards, a balloon is inserted into the lumen of the spermatic vein, through which the contrast agent is carried into the vascular bed. This helps to determine the structure and location of the entire venous vascular network and disturbances in blood flow in them.

Phlebography in in this case is not only diagnostic, but also therapeutic in nature. After the procedure and obtaining information about the cause of the problem, special substances are introduced into the lumen of the vessel - occluders or a sclerosant drug, which thrombose the left testicular vein.

Occluders are metal alloys made of titanium or platinum, which remain in the lumen of the vessel for life. This does not create any inconvenience for patients in the future when undergoing other diagnostic tests (for example, magnetic resonance imaging) or when passing through metal detectors.

Occluders block the vessel, eliminate varicocele and help prevent relapses in the future.

The technique is very convenient, as it significantly reduces the length of hospitalization; the patient can leave the hospital after 2 days. It is important to know that the introduction of occluders can provoke complications in the form of migration, thrombosis, and the occurrence of inflammatory processes. Such cases do occur, but very rarely.

The patient must limit the amount of physical activity for 3 months and increase it gradually. It may also bother you for about a month pain syndrome in the surgical area. After six months, you need to visit your doctor for a control ultrasound examination to check the healing process.

Contraindications to phlebography

Contraindications for venography of the lower extremities are allergic reactions to the contrast agent, inflammatory processes, acute and aggravated diseases of the liver and kidneys.

Brain examination is not performed in the presence of cardiac and neurostimulators, an insulin pump, hearing implants, aneurysmal clips, or surgical staples.

Also contraindicated are pregnancy and metal foreign bodies.

Pelvic phlebography is not performed during pregnancy and inflammatory diseases.

Conclusion

The phlebography method is quite accurate and useful, but is gradually fading into the background due to the improvement of non-invasive procedures.

Despite this, it will not be superfluous to know what it is - phlebography, the methodology for its implementation, indications and contraindications for it.

A Complete Review of Pelvic Varicose Veins

From this article you will learn: why varicose veins of the small pelvis are considered a separate disease, and not a type of varicose veins of the legs; who may get this disease and why. Manifestations and diagnosis of this pathology, how to treat it correctly, chances of recovery.

Varicose veins of the pelvis are weakening of the walls of the internal or external venous vessels of the pelvic region, leading to excessive expansion of their diameter (ectasia). Varicose veins are not able to ensure the outflow of blood from the pelvic organs, which leads to its stagnation and complete destruction of the vascular wall. The result is a disruption of the structure and functions of the female reproductive system.

The initial stages of the disease cause only minor discomfort in the external genitalia and lower abdomen. Women with advanced forms of pelvic varicose veins suffer from constant severe pain, various gynecological diseases, are infertile, and have a cosmetic defect in the form of convoluted dilated venous nodes on the perineum, labia or at the entrance to the vagina.

The disease can be completely cured, but lifelong prevention is necessary to prevent relapse. This problem is dealt with jointly by vascular surgeons or phlebologists and obstetrician-gynecologists.

Varicose veins of the small pelvis in men do not occur in the same form as in women. But a similar disease exists - varicocele. The mechanisms of occurrence and manifestations are similar to those of pelvic varicose veins. Vein dilatation occurs in the left testicle and along the spermatic cord due to the fact that blood stagnates in the left testicular vein. It is thrown back from the left renal vein, into which the testicular vein flows.

The essence of the pathology, how serious it is

The external and internal female genitalia are well supplied with blood. In order to ensure sufficient outflow of incoming blood, a powerful network of venous vessels is needed. Therefore, the venous system of the pelvis in women is well developed. Each vein has strong walls, is equipped with valves, and is connected to nearby veins. All this forms a smoothly functioning venous network of the pelvic region, which collects blood from the perineum, external reproductive organs (vulva, vagina), intrapelvic structures (ovaries, uterus), and transports it to the inferior vena cava.

Click on photo to enlarge

Varicose veins of the pelvis differ from healthy ones in that they:

  • Expanded in diameter;
  • Overflowing with blood;
  • Excessively crimped;
  • They have bag-like protrusions in the form of nodes;
  • Flabby and weak.

Pelvic veins affected by varicose veins can collect blood from the external genital and intrapelvic organs, but are not able to transport it normally to larger vessels (vena cava). This leads to the fact that the blood stagnates in the pelvis, and penetrating through the venous wall, it affects the tissues from which it should flow. They become swollen, congested, inflamed and lose their functions.

But most of all, varicose veins of the small pelvis are dangerous:

  • Dishormonal disorders of the ovaries;
  • Uterine bleeding and menstrual disorders;
  • Infertility, threat of miscarriage and impossibility of natural childbirth;
  • The formation of blood clots in the lumen of varicose veins, which threatens their separation from the site of formation and migration to the heart and blood vessels of the lungs. This is the most dangerous life-threatening complication - pulmonary embolism (PE).

Pulmonary embolism

Causes

Mostly, varicose veins of the pelvis occur in mature women:

Mechanisms of varicose degeneration of the pelvic venous system:

  1. (in 80%). They are the largest main veins that collect blood from the uterus and ovaries and carry it directly to the vena cava (right) or renal (left) vein. If a breakdown occurs in them, it completely blocks the venous outflow.
  2. Uniform weakening or destruction of the venous wall of all pelvic veins - they all simultaneously expand and are unable to contract to move blood to the overlying sections.
  3. The reverse flow of blood from the deep vein of the thigh into the superficial genital vein, which collects blood from the perineum and external genitalia, prevents outflow. As a result, the pressure in it increases, and its trunk and all tributaries expand.

The immediate reasons for the launch of these mechanisms may be:

  • Congenital weakness or dysplasia (underdevelopment) of the venous wall and valves.
  • Hormonal changes in female body(puberty, pregnancy, menopause, dyshormonal ovarian diseases).
  • Frequent inflammatory processes, endometriosis, operations, adhesions in the pelvis.
  • Previous thrombosis and thrombophlebitis of the pelvic veins.
  • Hard physical labor.
  • Prolonged stay in a lying or sitting position.
  • Overweight.
  • Pregnancy and childbirth.
  • Regular interruption of sexual intercourse for many years, especially in the absence of orgasm.
  • Bends of the uterus posteriorly or anteriorly.
  • Pelvic tumors.
  • Prolapse of the uterus.

Causes of varicose veins of the pelvis in women

Degrees of varicose veins - classification

Based on anatomical characteristics (prevalence), varicose veins of the small pelvis are divided into three types:

  1. Intrapelvic venous congestion;
  2. Vulvar and perineal varicose veins;
  3. Combined forms.

To reflect the nature of pathological changes, the disease is divided into three degrees:

  1. The first is that the dilated vessels of any of the organ plexuses of the pelvis do not exceed 0.5 cm in diameter and are excessively tortuous.
  2. The second is that the diameter of the veins increases to 1 cm, the process extends not only to the organ plexuses (uterine, ovarian), but also around them (periuterine tissue).
  3. The third is expansion (ectasia) of more than 1 cm, affecting all vessels - intraorgan, periorgan, and main (trunk of the ovarian vein).

The higher the degree of the disease, the worse the dilated veins and the more severe the stagnation of blood in the pelvis.

Characteristic symptoms

Women with pelvic varicose veins note:

  • Constant or periodic pain in the lower abdomen, intensifying in the evening or after exercise, mainly in the second half of the cycle (closer to menstruation). At grade 3, the pain can be very severe.
  • Itching, burning, swelling and cyanosis of the genitals.
  • Painful periods and sexual intercourse.
  • Heavy menstruation and uterine bleeding, irregular cycle.
  • Inability to get pregnant.
  • Thickened, tortuous veins in the perineum and labia.
  • Frequent painful urination.
  • Pronounced manifestations premenstrual syndrome.

Symptoms of varicose veins of the pelvis in women

Diagnostics

To confirm the diagnosis:

  • Ultrasound through the abdomen and through the vagina (transvaginally) using special sensors - Dopplerography and duplex angioscanning of the pelvic veins. The simplest and most informative method.
  • Endovascular phlebography is the introduction of X-ray contrast agents into the ovarian vein. Phlebography of the left testicular vein with filling of varicose veins with contrast agent
  • Computed tomography with contrast.
  • Diagnostic laparoscopy.

Treatment methods

Varicose veins of the pelvis are jointly treated by vascular surgeons or phlebologists with obstetricians and gynecologists. According to modern ideas, treatment consists of the following areas:

  1. Normalization of lifestyle;
  2. Conservative drug treatment;
  3. Compression and sclerosing therapy;
  4. Surgery.

It is possible to cure varicose veins of the pelvis. For this purpose, experts draw up individual plan treatment, and sick women must adhere to treatment and preventive recommendations for life.

1. Normalization of lifestyle

Since an incorrect lifestyle is a prerequisite and direct cause of pelvic varicose veins, its normalization will help to cure:

  • Avoid prolonged standing or sitting (more than 2-3 hours without a break).
  • Avoid heavy lifting and strenuous physical work.
  • During the day, perform unloading exercises for the pelvis (exercises “birch tree”, “bicycle”) or simply lie down for 10-15 minutes with the pelvis raised above body level.
  • Reduce weight (if obese).
  • Do not take a hot bath, replace it with a contrast shower.
  • Stop drinking alcohol and smoking.

2. Drug therapy

Treatment of pelvic varicose veins of any degree is not possible without drug support. In the first degree, it is the main treatment measure; in the second and third, it complements complex treatment.

The following drugs are used:

  • Phlebotonics - strengthen venous vessels (Detralex, Phlebodia, Venodiol, Normoven, Troxevasin).
  • Anticoagulants - thin the blood, facilitating its movement through the vessels (Cardiomagnyl, Clopidogrel, Trombonet, Warfarin).
  • Drugs that improve microcirculation (Trental, Pentoxifyline, Vazonit).

Additional groups of drugs are prescribed taking into account existing abnormalities in the body:

  • Preparations of female sex hormones (for dyshormonal disorders).
  • Painkillers and anti-inflammatory drugs (Ketoprofen, Ketonal, Diclofenac, Ibuprofen).
  • Hemostatics are hemostatic drugs for the treatment of uterine bleeding (Dicynon, Etamzilat, Sanghera, Tranexamic acid).

3. Compression and sclerosing therapy

One of the effective means in the treatment of varicose veins in the area of ​​the external genitalia and perineum is compression. The principle of this method is similar to the use of elastic bandages for varicose veins of the legs. External pressure (compression) of the superficial veins facilitates their emptying of blood. Special tights or shorts made of compression medical knitwear can create this effect. You can purchase them in specialized pharmacies, stores, and medical device stores, individually selecting the desired size and compression strength.

Sclerotherapy is a puncture of a varicose vein with the introduction of special drugs into the lumen (Sclerovein, Fibrovein, Aethoxysklerol), which cause it to stick together. This treatment is carried out for external (subcutaneous) pelvic varicose veins without hospitalization. Internal veins can also be sclerosed, but this procedure is technically more complex and takes place in an operating room.

4. Surgical treatment

Varicose veins of the pelvis are best treated surgically when:

  • 2–3 degrees of ectasia;
  • Rapid progression of the disease;
  • Planning pregnancy;
  • Severe pain syndrome;
  • Constant uterine bleeding and other gynecological disorders.

The main types of operations for pelvic varicose veins:

  1. Laparoscopic – intra-abdominal surgery through abdominal punctures. The ovarian vein is ligated, divided, or removed. This prevents the backflow of blood through it.
  2. Endovascular - intravascular intervention performed through a puncture of the femoral vein. Using a special catheter under X-ray control, the ovarian vein is found and embolized - the lumen is blocked. Endovascular intervention
  3. Removal of varicose veins - altered saphenous veins are removed through small punctures or incisions in the skin, and the external genital vein is ligated at the point where it enters the femoral vessels.
  4. Gynecological interventions – removal of tumors, elimination of uterine flexures.

Forecast

If pelvic varicose veins are not treated at all, over time they expand even more (95%), which can lead to dangerous complications. In the remaining 5% - women with subcutaneous varicose veins of the perineum of 1-2 degrees, in whom it arose after childbirth, the pathology does not worsen, but will never go away on its own.

If you treat the disease, you can achieve complete recovery (10–50% depending on the degree) or significant improvement (45–50%), especially if surgical methods are combined with conservative ones. But in any case, after complex treatment, lifelong prevention should be carried out, consisting of following lifestyle recommendations, periodic medication or compression support for weakened veins.

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Varicose veins of the pelvis

Varicose veins of the small pelvis are ectasia of the vessels of the venous system of the small pelvis, leading to impaired blood flow from the internal and external genital organs. It manifests itself as a visible dilation of the perineal and vulvar veins, accompanied by local swelling, a feeling of heaviness and bursting pain, and bleeding. Pelvic pain, dysmenorrhea, dyspareunia and other symptoms are characteristic. Varicose veins of the pelvis are diagnosed through a gynecological examination and ultrasound with colorectal dosage, phlebography, CT, and laparoscopy. Treatment of the syndrome can be conservative (taking venotonics, exercise therapy) or surgical (scleroobliteration/embolization of gonadal veins, phlebectomy, etc.).

Varicose veins of the pelvis

Pelvic varicose veins (PVVV) is a disease of the pelvic veins associated with a violation of their architectonics and stagnation of venous blood in the pelvis. In the literature, varicose veins of the small pelvis are also referred to as “pelvic venous congestion syndrome”, “varicocele in women”, “chronic venous congestion syndrome”. pelvic pain" The prevalence of pelvic varicose veins increases in proportion to age: from 19.4% in girls under 17 years of age to 80% in perimenopausal women. Most often, pathology of the pelvic veins is diagnosed in the reproductive period in patients in the age group. In the vast majority of cases (80%), varicose transformation affects the ovarian veins and extremely rarely (1%) is observed in the veins of the broad ligament of the uterus. According to modern medical approaches, treatment of ARVMT should be carried out not so much from the standpoint of gynecology, but, above all, from the standpoint of phlebology.

Causes of ARVMT

The pathomorphological basis of varicose veins of the small pelvis is considered to be connective tissue dysplasia, which occurs in 35% of practically healthy people. This condition is congenital and is characterized by a decrease in the content of certain types of collagen, causing a decrease in the strength of connective tissue, including that making up the vessel wall. An extreme manifestation of such a pathology may be the underdevelopment or absence of any morphological component of the vascular wall. Systemic damage to the connective tissue explains the frequent combination of ARVMT with varicose veins of the lower extremities and hemorrhoids. In addition to connective tissue dysplasia, sex hormones (mainly progesterone), PID, and pelvic vein thrombosis have a certain “weakening” effect on the tone of the pelvic venous system in women.

Factors that increase the risk of varicose veins of the small pelvis are heavy physical activity; work involving forced long-term standing or sitting; pregnancy and childbirth, pelvic injuries, lack of orgasm in a woman. Of the gynecological diseases, the most significant influence on the development of URVMT is exerted by endometriosis, prolapse of the vagina and uterus, tumors of the uterus and ovaries, uterine retroflexion, etc. The triggering role of hormonal contraception and hormone replacement therapy cannot be excluded.

Classification of HRVMT

Varicose veins of the small pelvis can manifest themselves in two forms: varicose veins of the vulva and perineum and venous congestion syndrome. In more than half of the cases, both of these forms determine and support each other. Isolated vulvar and perineal varicose veins often result from reflux of blood through the saphenofemoral anastomosis involving the external pudendal vein and the tributary of the great saphenous vein. It occurs in 30% of pregnant women and persists after childbirth in 2-10% of women. The main provoking factor for varicose veins of the perineum and vulva is the pressure of the growing uterus on the iliac and inferior vena cava. The pathomorphological prerequisite for varicose veins of the small pelvis is the reflux of blood through the ovarian vein.

There are 3 degrees of severity of varicose veins of the small pelvis, taking into account the diameter and localization of venous ectasia:

1st degree - dilated vessels have a diameter of up to 0.5 cm and a tortuous course; the lesion may affect any of the venous plexuses of the pelvis;

2nd degree - dilated vessels have a diameter of 0.6-1 cm; the lesion may be total in nature or affect the ovarian plexus, or parametric veins, or arcuate veins of the myometrium;

3rd degree - dilated vessels have a diameter of more than 1 cm with varicose veins of the total type or main type (parametric localization).

Symptoms of ARVMT

The basis of the clinical picture of vulvar and perineal varicose veins is the expansion of venous vessels visible to the eye in this area. Subjective complaints may include sensations of itching, discomfort, heaviness and bursting pain in the external genitalia. Upon examination, swelling of the labia may be detected. Spontaneous or post-traumatic bleeding may occur, most often provoked by sexual intercourse or childbirth. Due to the thinning of the venous wall and high pressure in varicose veins, stopping such bleeding is associated with certain difficulties. Another complication of varicose veins of this localization can be acute thrombophlebitis of the perineal veins. In this case, intense pain, hyperemia and swelling of the perineal skin occur. Veins affected by varicose veins become dense and painful to the touch. Hyperthermic syndrome develops - an increase in body temperature to 37.5-38.0 °C.

Another form of varicose veins of the small pelvis - venous congestion syndrome - can give a polymorphic clinical picture, and therefore is often mistaken for inflammatory gynecological pathology, colitis, cystitis, lumbosacral radiculitis, etc. The most constant symptom is pain in the lower abdomen, having different intensity, character and irradiation. More often, patients describe their sensations as aching pain radiating to the lumbosacral region, groin or perineum. Almost half of women with varicose veins of the small pelvis note an increase in pain in the second phase menstrual cycle. Pain is often triggered by sexual intercourse, prolonged sitting or standing, or physical activity. Pelvic venous congestion syndrome is typically characterized by the presence of severe premenstrual syndrome, algodismenorrhea, dyspareunia, and dysuric disorders.

Diagnosis of HRVMT

Diagnosis of varicose veins of the small pelvis consists of a standard gynecological examination, ultrasound scanning of the OMT and veins of the lower extremities, pelvic venography, CT scan of the pelvis, and laparoscopy. A gynecologist and phlebologist should participate in the examination of patients with suspected URVMT.

When examining the external genitalia, dilated superficial veins are found in the vulva and perineum; Vaginal examination reveals cyanosis of the vaginal walls and pain on palpation of the abdomen. Sonography of the pelvic organs allows confirmation of URVMT, while the most informative is a combined ultrasound TA + TV access. The study not only makes it possible to identify organic pathology, but also, using the Color Doppler mode, to detect conglomerates of varicose veins with altered blood flow, and pathological blood reflux. According to Doppler ultrasound of blood vessels a decrease in peak blood flow velocity in the uterine, ovarian and internal iliac veins is determined. As part of assessing the patient’s phlebological status, it is advisable to conduct an ultrasound angioscanning of the veins of the lower extremities.

In order to study the localization and prevalence of varicose veins of the small pelvis, the condition of the valve system and venous anastomoses, as well as the detection of blood clots, transuterine venography is performed. In case of venous congestion syndrome, selective oophorography may be indicated, which involves the injection of contrast directly into the ovarian veins. For isolated vulvar-perineal varicose veins, varicography is used - contrasting the veins of the perineum. Currently, X-ray contrast examination is being replaced by CT of the pelvic organs, which is not inferior to them in diagnostic significance. As part of the differential diagnosis, as well as when the listed methods are insufficiently informative, diagnostic laparoscopy is resorted to.

Treatment of ARVMT

During pregnancy, only symptomatic treatment of varicose veins of the small pelvis is possible. It is recommended to wear compression tights and take phlebotonics (diosmin, hesperidin) on the recommendation of a vascular surgeon. In the II-III trimester, phlebosclerosis of perineal varicose veins can be performed. If, due to varicose veins, there is a high risk of bleeding during spontaneous childbirth, the choice is made in favor of surgical delivery.

Conservative tactics can be effective for grade 1-2 URVMT. A course of venoactive and antiplatelet drugs, NSAIDs, exercise therapy, ascending contrast showers, normalization of working conditions and physical activity, selection of compression stockings and other measures can slow down the progression of varicose veins and significantly improve well-being. If dysfunctional uterine bleeding occurs, hemostatic therapy is prescribed. In some cases, the patient may need the help of a psychotherapist.

Intractable pain syndrome, as well as grade 3 pelvic varicose veins, are indications for surgical treatment of the pathology. TO modern methods Minimally invasive surgery includes scleroobliteration or embolization of the ovarian veins, which are performed under angiographic control. During the intervention, under local anesthesia, a sclerosant is injected into the lumen of the vessel or an embolization coil is installed, resulting in obliteration/occlusion of the gonadal vein. A possible alternative is resection of the ovarian veins using a laparotomic or retroperitoneal approach, or their endoscopic clipping. If the cause of ARVMT is uterine retroflexion, plastic surgery of its ligamentous apparatus is performed.

For isolated vulvar and perineal varicose veins, a miniphlebectomy or phlebectomy in the perineum can be performed. The operation is often supplemented by resection of the labia minora or majora. In the case of a combination of varicose veins of the perineum and lower extremities, crossectomy is indicated.

Prevention of ARVMT

Preventive measures aimed at reducing the risk of occurrence and progression of pelvic varicose veins come down mainly to normalizing lifestyle. In this series, the leading role belongs to the exclusion of long-term static and severe physical activity, correcting the diet (including a large amount of fruits and vegetables), giving up alcohol and smoking. For initial signs of varicose veins, therapeutic and breathing exercises, wearing compression stockings, and preventive and anti-relapse courses of conservative therapy are recommended. In this case, it is possible to achieve long-term remission and improve the quality of life of patients.

Varicose veins of the pelvis - treatment in Moscow

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Varicose veins of the pelvis in women: who will help - a phlebologist or a gynecologist?

When mentioning a disease such as varicose veins, most people imagine pathological processes in the lower extremities that are visible to the naked eye. Varicose veins of the pelvis - this type of disease is spoken and written about much less often. Often its signs are regarded as the presence of inflammatory processes in the genital organs, some hormonal disorders, pathologies of the urinary system, lumbar radiculitis.

In women, varicose veins of the pelvic organs are caused by stretching of the walls of the veins, reducing their strength. The peak incidence occurs in the reproductive age range from 25 to 50 years. Sometimes varicose veins can be detected in teenage girls during a period of rapid growth and the formation of hormonal levels and the menstrual cycle. At this age, the disease may be asymptomatic.

Another feature of the pathology is the tendency to worsen and actively manifest itself during the period of bearing a child.

Signs and causes

Obstruction of the veins and disruptions in the normal circulatory system in the ovaries lead to disruptions in the circulatory system. A provoking factor in the development of the disease may be connective tissue dysplasia, leading to a decrease in the amount of collagen and, as a consequence, the elasticity and strength of blood vessels.

General negative factors and reasons for the development of varicose veins of the small pelvis:

  • pregnancy period due to an increase in blood volume in the vessels, increased progesterone content, and large size of the uterus;
  • regular intense physical activity;
  • multiple previous pregnancies and births;
  • sedentary lifestyle, with predominantly sedentary activities;
  • gynecological diseases: pathological structure of the uterus, endometriosis, inflammatory processes;
  • the practice of interrupting sexual intercourse for a long time in order to protect against unwanted pregnancy;
  • long-term use of certain hormonal drugs;
  • lack of satisfaction with sex life.

Hormonal imbalance, in particular an increase in estrogen levels, can provoke the development of varicose veins.

As already noted, pelvic varicose veins manifest themselves similarly to diseases of the female reproductive system. The main sign that makes you wary is constant pain. They are felt in the lower abdomen and can be either weak, barely noticeable, or intensely sharp. Very often, severe pain, occurring in the pelvis, spreads to the lumbar or sacral area. The pain becomes more severe after physical exertion or, conversely, after a long stay in the same position (sitting or standing).

Pelvic venous system in women

The following symptoms that manifest varicose veins of the small pelvis should be highlighted:

  • increased bleeding after childbirth or gynecological procedures caused by thinning of the venous wall; it is difficult to stop such bleeding;
  • painful sexual intercourse, a feeling of sexual dissatisfaction, fear and disgust for sexual life in general, the appearance of strong muscle spasms when trying to enter into intimacy;
  • painful or frequent urination caused by a full bladder;
  • enlargement of the veins of the vulva or perineum, accompanied by severe itching, swelling, burning;
  • thrombophlebitis of the veins, which is characterized by swelling or redness of the skin of the perineum, fever and general weakness.

A distinction is made between varicose veins of the vulva and the development of the disease as a result of venous congestion. The disease can have three degrees of intensity.

  • 1st degree – the diameter of the vein is 4-5 mm;
  • 2 degrees – the vein increases to 6-10 m;
  • Grade 3 – vein diameter exceeds 10 mm.

Determining the severity of the pathology is one of the main stages of diagnosis, as it helps determine treatment methods. In the first two cases, conservative treatment, changes in the nutritional system, and use of therapeutic exercises. The third degree of severity of the disease requires surgery and ligation of large veins.

Varicose veins of the pelvis during pregnancy

This disease is a problem for women who have given birth repeatedly. Changes in the veins can occur already during the first pregnancy, and with each subsequent pregnancy the risk increases. At a certain stage, the veins of the organs cease to function fully, preventing the normal outflow of blood.

The risk increases if a woman:

  • an abnormal structure of the reproductive organs (primarily the uterus) was diagnosed;
  • there is a genetic predisposition;
  • excess weight or rapid weight gain throughout pregnancy;
  • have bad habits (smoking);
  • work that requires little physical effort, long periods of sitting or standing in one place.

Why is the disease so often diagnosed in pregnant women?

This pathology affects women in the third trimester, since the enlarging uterus puts pressure on nearby organs, creating obstacles to their normal activities.

The normal volume of circulating blood in the body increases by almost 50% during gestation. The veins do not always cope with the increased load on them, especially if the situation is aggravated by various provoking factors discussed above.

Characteristic changes in hormonal levels in the body of the expectant mother can also have a bad effect on the elasticity of the walls of blood vessels.

What is dangerous about pathological enlargement of veins during gestation?

Varicose veins of the uterus and other organs threaten a difficult birth with serious consequences. Thinning vein walls can become injured and even rupture, causing pain and bleeding. These phenomena are harmful and dangerous not only for a woman’s well-being, but also for her life.

One of the most common disorders is the risk of blood clots. They block blood vessels, reducing or completely preventing the normal supply of blood to the placenta. This dysfunction leads to aging of the placenta and oxygen starvation of the fetus.

At stages 1 and 2 of varicose veins of the small pelvis, childbirth, as a rule, occurs naturally. During pushing, medical personnel ensure that the pressure in the walls of the blood vessels is reduced. Simultaneous administration of blood thinning drugs is necessary.

The severe (3rd) form requires a cesarean section.

If this problem exists, the pregnant woman should carefully prepare for future births, namely:

  • starting from the second trimester, wear a prenatal bandage;
  • move actively, avoid prolonged sitting or standing in one position (for example, while at the computer);
  • to reduce pressure in blood vessels during sleep, place a special pillow between your legs;
  • visit the pool or regularly take a contrast shower.

Expectant mothers need to reconsider their diet, ensuring timely bowel movements.

Diagnostics

External gynecological examination allows you to easily identify varicose veins of the vulva and perineum. But how to check whether there is a similar pathology in the internal genital organs? To accurately determine the problem, additional examinations are prescribed, such as ultrasound diagnostics, venography, laparoscopy, computed tomography or MRI.

Treatment

The disease does not belong to gynecological pathologies. His treatment is carried out by a phlebologist (vascular surgeon). But since pathology is often detected during an ultrasound, the woman is subsequently observed by two specialists - a gynecologist and a phlebologist. Treatment of varicose veins of the small pelvis should be comprehensive, including drug and non-drug therapy, the use of therapeutic exercises, normalization of the nutrition system and revision of the daily routine.

Medications are effective in eliminating symptoms at the initial stage. Patients are prescribed medications during an exacerbation period. Long-term use of such drugs is undesirable, since they tend to cause side effects. Medicines improve blood circulation, relieve inflammation and pain, and reduce the risk of blood clots.

How to treat dilated pelvic veins in pregnant women, and how justified drug therapy in this case?

Given the potential harm to the fetus and the high risk of side effects, drugs are prescribed no earlier than the second trimester and only in exceptional cases. If a woman has never had any such symptoms before pregnancy, medical problems, most often she is recommended to limit herself to non-drug methods of therapy, for example, wearing special underwear.

Let's look at the use of some medications:

The main active ingredient of the product is diosmin. Release form: tablets. Taking the drug reduces congestion in the pelvic area, stimulates venous outflow and blood circulation. It is well tolerated, but in some cases allergic skin reactions are possible, headache, upset bowel movements or nausea. Not recommended for persons with hypersensitivity to the components of the product and children under the age of majority.

Pregnant women are prescribed the medicine after consulting a doctor, for a period not earlier than 12 weeks.

The active substance is dipyridamole. Available in tablet form. Recommended for the treatment and prevention of varicose veins, thrombosis and their complications. Contraindications include disorders of the heart and blood vessels, liver failure, and peptic ulcers.

After long-term use, side effects are possible: headache, skin rash, increased heart rate, flushing of the face, disorders of the digestive system. During pregnancy, it is prescribed according to indications when the expected benefit outweighs the possible risks to the fetus.

Used in complex therapy together with another drug Phlogenzyme. Wobenzym contains plant extracts (pineapple and papaya) and animal pancreas extracts. The combined drug has an anti-inflammatory, decongestant, analgesic effect. Release form: tablets.

Side effects are rare, including urticaria and minor skin rashes. Contraindications include hemophilia and individual intolerance to the components of the product.

Gymnastics will help eliminate congestion in the pelvis. Most exercises are performed in a lying position. This can be the famous “birch tree”, “bicycle”, “scissors”. When they are performed, there is a sufficient load on the lower abdomen, promoting the outflow of blood. Physiotherapy complemented by wearing compression stockings.

Among the treatment methods, hirudotherapy and treatment with leeches, which are placed in the tailbone area, are also used.

Folk remedies

Facilities traditional medicine effective in overcoming the symptoms of the disease if applied to early stages. Teas and decoctions of chaga and dandelion root, tinctures based on horse chestnut.

Most affordable way uses of chaga - medicinal tea based on it. To do this, pour 3 tablespoons of dried chaga into 0.5 liters of boiled water and leave in a warm place for several hours. Take half an hour before meals, no more than 2-3 times a day.

A dessert spoon of crushed dandelion root is poured into a glass of boiling water, left for several hours and drunk three times a day, minutes before meals. This tea is contraindicated for people suffering from gastritis or biliary tract disease.

To prepare horse chestnut tincture, the fruits are peeled, finely chopped, placed in a dark glass bottle and filled with vodka in a ratio of 1:10. The duration of infusion is 14 days. Drops of the resulting tincture are mixed with a small amount of water and taken three times a day. The duration of treatment should not exceed 30 days.

Diet

Great importance in the treatment of the disease has balanced diet excluding fatty foods and alcoholic drinks. The menu should include dishes high in fiber and vegetable fats. The main products in the diet should be vegetables, fruits, natural juices, green tea. Sweet baked goods, dishes with a lot of spices, and fast food are not recommended. Meals should be frequent, but in small portions.

Foods high in vitamin C (citrus fruits, black currants), seafood (oysters, shrimp, seaweed) are beneficial. Dishes should be prepared with a minimum amount of salt.

Prevention

Conservative methods of therapy significantly alleviate the condition of patients and eliminate the risk of developing severe consequences. The main goal of treatment is to prevent relapses and the need for surgical intervention. Prevention of the disease and its relapses is of great importance.

  1. Use hormonal drugs only as prescribed by a doctor and under his supervision.
  2. Lead an active lifestyle with moderate physical activity.
  3. Eliminate bad habits such as smoking and drinking alcoholic beverages.
  4. Regularly perform a set of gymnastic exercises to support vascular health.
  5. Eat a healthy diet with plenty of vegetables and fruits.
  6. Wear compression stockings when the first signs of varicose veins appear.

Reviewing your diet, active lifestyle, regular visits to the doctor, and treatment of dilated pelvic veins immediately after identifying the disease will eliminate painful symptoms and help avoid surgery for a long time.

Phlebography – what is it? – a completely natural question arises from people who are prescribed such a procedure. An unfamiliar word causes fear and anxiety: is it painful, is it dangerous, what complications might there be? There is no need to be afraid: the procedure is simple and safe. In addition, when it comes to assessing health status, there should be no doubt: the benefits will in any case outweigh the risks. What kind of procedure is this, why, when and how it is carried out - read in this article.

Phlebography (or venography) is a study of veins, one of the types of angiography. Angiography is a diagnostic method using a contrast agent, used in radiography, fluoroscopy, computed tomography and in the hybrid operating room. Phlebography is also performed by injecting a contrast agent into the vessels using x-rays. An iodine-based substance helps visualize the condition of blood vessels in photographs.

The procedure allows you to determine the condition of the veins, the presence or absence of blood clots. Helps identify vascular diseases - even in the initial stages, and is also used to distinguish one pathology from another - for example, varicose veins. It also makes it possible to assess the length of the vessels, their narrowing or dilatation, localization and severity of the disease.

Phlebography of veins is divided into two types: ascending and retrograde. Ascending is carried out when the patient is lying down, horizontally. Its essence is aimed at determining the occupancy of the vascular bed. Retrograde - with an inclination, using the Valsalva maneuver. Its task is to check the condition and functionality of the valves.

Phlebography is performed for the veins of the lower and upper extremities, pelvis, head area, and (varicose veins in the area of ​​the external genitalia of a man).

Phlebography of the lower extremities

Phlebography of the lower extremities makes it possible to determine the condition of the vessels in the legs, the presence or absence of varicose veins, thrombosis or thrombophlebitis. Here's what you can identify using this method:

The introduction of a contrast agent allows you to see the full picture: where and how the vessels are located, their pattern, thickness and condition.

Phlebography of the veins of the lower extremities is performed quite often and is a popular research method, but only after other methods have failed, or the doctor has doubts about making a diagnosis.

The main advantage of venography is its simplicity and relative safety for the patient - the risk of complications is minimal and they occur extremely rarely. At the same time, the method is quite informative and helps to create a complete picture of what is happening.

When is it carried out?

Phlebography is carried out as prescribed by a doctor, in case of doubt about the diagnosis or to confirm it, in controversial situations. The main indications for using the method will be:

  • varicose veins of varying severity;
  • postthrombophlebitic syndrome;
  • determination of the localization of thrombosis or thrombophlebitis;
  • planning the infusion of the drug into the lumen of the vessel - for example, during sclerotherapy;
  • with heart failure;
  • before performing vascular surgery;
  • with changes in heart rate.

And also in the presence of other problems with the veins of the lower extremities, to determine the severity of the diseases, their location and extent.

Important! Do not be afraid of the procedure - it is simple and relatively painless - only the injection of fluid into the vein causes minor discomfort. And at the patient's request, analgesics can be used.

Preparation for phlebography

Preparation for this diagnostic method is basically not much different from preparation for most similar procedures. All manipulations are carried out on the direction of the doctor and with the written permission of the patient, certified by his signature - this concerns the formal part of the preliminary stage.

Physical preparation consists of abstaining from food for four to five hours before the appointed time. It is allowed to drink clean water; other drinks, like food, are prohibited. Immediately before the diagnosis, you should try to empty your bladder.

In addition, before the procedure, the doctor must make sure that the patient is not allergic to the contrast agent, and if necessary, if the patient has a strong painful reaction to the administration of the drugs, give him an anesthetic.

Progress of the procedure

The procedure is carried out lying down. The patient lies on a bed, and a pressure bandage is applied to his lower leg. This will increase blood flow. After puncturing the superficial vein of the foot, saline solution is injected into the vein. Then comes the turn of the contrast agent. Its introduction should be slow and gradual.

While the iodine-containing substance spreads through the vessels, the doctor, using an X-ray machine, monitors its progress on the screen. Pictures are taken throughout the procedure.

After the condition of the veins has been sufficiently studied, the leg is sharply raised upward so that the substance is removed out. Once this has been achieved, the needle is removed and a bandage is applied to the wound site. To cleanse the blood of residual contrast agent, an additional saline solution can be injected.

To assess the health and capacity of the valves, venography is performed with the limb in an upright position.

The duration of the procedure is no more than a few minutes. During this time, the doctor manages to take up to a dozen pictures.

Contraindications to phlebography

The main contraindications to diagnosis using venography of the extremities, pelvis and other areas will be:

  • pregnancy;
  • the presence of certain inflammatory diseases;
  • kidney disease in the acute stage;
  • some liver diseases in the acute stage;
  • intolerance to iodine-containing substances.

As for cerebral venography, it cannot be performed in the presence of cardiac and neurostimulators, an insulin pump, hearing implants, aneurysmal clips, surgical staples, or other foreign metal bodies in the body.

Also, the doctor must take into account the risk in advance possible complications. They occur rarely, and include phlebitis, abscesses, phlegmon, inflammation in the wound area, simply severe pain and deterioration in general well-being.

Conclusion

Phlebography is an accurate, informative, yet fast and not particularly uncomfortable diagnostic method for the patient. He is able to give the most complete picture regarding the health of the veins and not only them. Venography is necessary for differential diagnosis and in preparation for surgery - to determine the exact location of veins and valves. There is no need to be afraid of such a procedure - it is practically painless, quick, and the risk of complications is minimal.

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