Chapter 26 - Venography Flashcards
Indication for catheter directed venography
1) DVT with non-diagnostic US or negative US when suspicion high 2) adjunct during intervention 3) evaluation of valve prior to stripping GSV 4) venous mapping prior to surgical procedure 5) evaluate venous stenosis or venous hypertension 6) evaluate venous malformation 7) pre-op evaluate tumor involvement
Relative contraindication of venography
1) cellulitis 2) iodinated ccontrast allergy 3) renal insufficiency not on dialysis (especially DM and CHF)
Comparison of various venous imaging modalities
TABLE 26.1
Grades of venous refluex
TABLE 26.2
Symptoms of pelvic venous congestion syndrome
1) pelvic pain 2) dysmenorrhea 3) dysuria 4) dyspareunia 5) vulvar/pelvic varices in women 6) varicocele in men
Source of pelvic congestion
1) ovarian vein reflux 2) pelvic varices 3) hypogastric venous insufficiency
Ovarian veins provides drainage from
1) parametrium 2) cervix 3) mesosalpinx 4) pampiniform plexus
Ovarian vein anatomy
2-3 trunks form single vein at L4 Right ovarian drains into IVC left ovarian drains left renal vein 3.1 mm diameter with 2-3 valves
Pressure gradient between left renal vein and IVC
Nutcracker syndrome any gradient > 1 mmHg counts, normally should be zero
Diagnostic criteria for pelvic congestion syndrome
1) ovarian vein > 6mm 2) retention of contrast > 20 seconds 3) congestion of pelvic venous plexus or opacification of ipsilateral/contralateral iliac veins 4) filling of vulvovaginal/thigh varicosities each variable score 1-3 total > 5 is pelvic congestion
Causes of varicocele formation
1) abnormal distention of pampiniform venous plexus (drainage from testicle) 2) absence of testicular vein valves
Testicle venous drainage anatomy
1) Veins of testes + epididymis –> pampiniform plexus 2) plexus from scrotum to spermatic cord –> ascend in front of ductus deferens 3) pampiniform plexus unite to form 3-4 veins –> enter abdomen through inguinal ring 4) coalesce to two gonadal veins 5) right enter IVC; left enter left renal vein
Collaterals of venous drainage from testes
1) perirenal 2) retroperitoneal 3) lumbar veins
Most common sidedness of varicocele
LEFT right or bilateral only accounts for 10-15% and ? tumor/adenopathy
Diagnostic of varicocele
1) two prominent tortuous veins in pampiniform > 2mm on US 2) increase with valsalva 3) reflux > 2 sec on venography 4) nitroglycerin if spasm 5) internal iliac study with occlusion balloon if needed
Treatment of varicocele
Occlusion of testicular vein from inguinal ligament to 5cm below convergence with left renal vein Coils 10% larger than vein
Renal vein thrombosis causes
1) thrombus propagating from below to obstruct IVC and renal veins 2) caval obstruction/invasion from malignant neoplasm with compromise of renal vein 3) primary renal vein thrombosis 4) renal vein thrombosis secondary to nephritis
How to visualize SMV
SMA injection then image in delayed phase
How to visualize portal venous system
1) Transcutaneous transhepatic 2) transjugular intrahepatic approach
Portal vein comes from
SMV + splenic vein
Budd-chiari syndrome define
Thrombosis of hepatic venous outflow causes portal HTN
Budd-chiari causes
1) membranous obstruction of IVC 2) pregnancy 3) oral contraceptive 4) tumors 5) infection 6) blood dyscrasias 7) idiopathic
Characteristic of budd chiari on venography
1) spiderlike appearance of occluded/recanalized hepatic vein 2) distal occlusion of IVC = weblike band of stenosis
Key in imaging of the upper extremity venous system
Arm at rest then arm abducted to stress the outlet provocative maneuver
Pulmonary artery angiography key points
1) care with right ventricle = RBBB and cause complete HB in people with existing LBBB 2) large volume contrast contraindicated in pulmonary HTN (20 mmHg)
Risk of venography
1) pain at site 2) infection 3) extravasation 4) allergy 5) thrombophlebitis 6) intraabdominal bleed via transhepatic approach 7) DVT 8) PE 9) portal vein thrombosis
