Venogram

An x ray taken of the blood flow through the veins in certain area of the body is called venogram. This is done by inserting a certain special dye into the veins so that it can be seen clearly on the X ray image. This is done to study the condition of the veins and the valves in veins.

Venogram can show the veins in the legs, arm, and pelvis, veins leading to the heart or leaving the kidneys. The patient is advised not to eat at least four hours prior to venogram. You may drink only clear fluids for four hours before the test. It is better for the patient to apprise the doctor on certain things as given below before a venogram is done:

• if she is pregnant
  
• is allergic to certain drugs
  
• has bleeding problems or has taken blood thinning medications
  
• has asthma
  
• has severe allergic reactions
  
• has kidney problems
  
• has diabetes and is on medication.

The patient is required to sign a written consent for this procedure. Venogram is done in a hospital x ray department by a radiologist and an x ray technologist. A nurse is also present. The patient is asked to remove any jewelry before the test. Most of the clothes need to be taken off. A gown is given to the patient to wear during the test. The patient is advised to urinate just before the test begins. The patient is made to lie on a table and a tilting x ray table is used to study the legs. The patient is fitted with safety straps to lie still even if the table is tilted.

In case of a leg venogram, the patient is asked to relax the leg and keep it still during the x ray. An elastic band is put around the leg as this enables the veins of the foot fill with blood. The dye is inserted into the vein on the top of the foot. If the veins of the pelvis are to be studied, the dye is placed in a vein on the groin and for an arm venogram; the dye is put into the vein on the top of the hand or in the arm. After inserting the dye, x ray from different angles/views are taken.

After the x rays are taken, saline is inserted into the vein to help flush out the dye. To prevent blood clot, sometimes a blood thinner is put into the veins. The duration of the procedure is about 30 to 45 minutes. You will feel a quick pinch when medicine for numbness is given. A warm flush or a metallic taste in the mouth may be felt when the dye is put into the vein.

Venogram has certain risks which includes allergic reaction to the dye, infection or damage to the veins, deep thrombosis of the veins in very rare cases, kidney problems, and damage to cell tissue due to radiation. It is better to call the doctor immediately if after the test the patient has a fever or suffers increasing pain, redness and swelling in the arm or leg. As for results of venogram, if the dye moves quickly and evenly through the veins, the results are normal. If the flow is blocked or slowed, then the results are abnormal. This means, there is a blood clot or some other problems such as damage in the vein.

Deep Venous Thrombosis

Deep Venous Thrombosis (DVT) is a condition wherein a blood clot develops in a deep vein that accompanies an artery, mostly in the lower limbs. Consequently, the clot affects blood circulation. Usually thrombosis sets in when the coagulation function is impaired or imbalanced due to abnormalities in the blood, altered blood flow or damage to the blood vessels. Typically the main veins affected by deep venous thrombosis are inner thigh, calf, groin and lower abdomen. A person suffering from deep vein thrombosis is likely to experience pain and swelling in the affected limbs. The pain in the affected leg can become so severe that the person is unable to bear weight on it. This condition is different from arterial thrombosis where the clot forms in the arteries. The main risk factor associated with deep venous thrombosis is that the clot may break off and travel along the blood stream to lodge itself in the lungs, heart or brain. This disease is usually noticed in adults over 60 years.

Deep Venous Thrombosis - DVT is brought about by reduced blood flow or thickening of the blood. Persons who have undergone surgery and been given anti-clotting drugs are likely to develop this condition. Long car or plane journeys, fractures, birth control pills and surgery are potential conditions that may lead to this disease. Those with a history of polycythemia vera or hypercoagulability are more likely to suffer this condition. One of the potential dangers of deep venous thrombosis is pulmonary embolism. Pulmonary embolism is a serious, life-threatening condition where the embolism blocks or closes the artery in the lung. Another complication of deep venous thrombosis is post-thrombotic syndrome characterized by edema, hyper pigmentation and skin ulceration.

Some of the diagnostic tests that help detect deep venous thrombosis are Ultrasound Doppler, Venography of the legs and D-dimer blood test. The Doppler ultrasound aids in studying the reduced blood flow in the affected limbs. The venogram is a special x-ray that reveals any blood clot that is responsible for obstructed blood flow. Magnetic Resonance (MR) Venography with Gadolinium contrast is considered as a prime imaging modality in the diagnosis of DVT.

The blood tests can reveal the clotting tendency. Heparin is an anticoagulant that has been intravenously given to a patient along with oral Warfarin. These medications cause an increase in clotting time. But careful monitoring is of the essence so as to avoid the risk of hemorrhage.