Diagnostic Phlebography

Background and indications

Phlebography (venography) is a diagnostic endovascular examination involving contrast injection into the venous system under fluoroscopic guidance to visualize venous anatomy and detect stenoses, occlusions, or anomalies. Although largely replaced by Doppler ultrasound and CT angiography, phlebography remains indispensable in certain situations: pre-interventional venous mapping, central venous stenosis evaluation (subclavian vein, brachiocephalic trunks), post-thrombotic syndrome workup, and complex venous malformation visualization.

Pre-procedure assessment

Assessment includes prior venous Doppler ultrasound, renal function verification (iodinated contrast injection), and contrast allergy screening.

Procedure

Under local anesthesia, peripheral venous access (foot for lower extremities, hand or antecubital fossa for upper extremities, femoral or jugular for central veins) is obtained. Contrast is injected manually or by power injector, and serial fluoroscopic images are acquired. The examination may be complemented by IVUS (intravascular ultrasound) for precise stenosis evaluation. The procedure takes 15-30 minutes.

Results and scientific evidence

Phlebography remains the gold standard for central venous stenosis evaluation, with sensitivity and specificity > 95%. Phlebography + IVUS is the reference method for iliofemoral venous stenting planning.

Risks and complications

Contrast allergic reaction (< 1%), nephrotoxicity (low risk, preventive hydration), access site hematoma (2-3%), venous thrombosis (< 1%). The examination is considered low-risk.

Recovery

Same-day discharge. Post-procedure hydration. Results available immediately.

Practical information

The procedure is performed as an outpatient. It is performed by an interventional radiologist.