Diagnosis Using Venous Venography
Venous venography is used to identify and plan therapeutic protocols for venous insufficiency, venous hypertension, thrombosis, and varicose developments. Prior to that, the accuracy, affordability, and non-invasive nature of ultrasound is used as a both a screen and as a first step when signs and symptoms of a venous disorder present.
Duplex ultrasound is the combination of two ultrasonic technologies:
- B (brightness) mode: To reflect sound waves off of tissues of different densities to render an image of structure.
- Doppler flow ultrasonography: To evaluate motion of blood flow and to identify venous stasis and sluggishness or obstruction to this flow.
For patients who have venous insufficiency but uncertain ultrasound findings, a catheter can be used to enhance the imaging used in multidetector computed tomography (MDCT) or magnetic resonance (MR) venography. These techniques are used for confirming inconclusive venous disease, imaging difficult areas to visualize ultrasonographically, or for planning surgical interventions.
For suspicion of thrombosis in deep venous systems, such as the hepatic portal system or the intestinal mesenteric veins, CT (MDCT) and MR venography are needed to make a definitive diagnosis. These venous channels and their tributaries are simply too deep for ultrasound accuracy in conditions for which accuracy is crucial to prevent disastrous events such as bowel ischemia or liver complications (portal hypertension and other liver-related illness).
In some circumstances, arterial disease is either the precursor or the cause of venous disease, and persons with risk factors for peripheral arterial disease (smokers, diabetics, hypertensive, hyperlipidemia) should have arterial imaging included in the venous diagnostic approach.
When thrombosis within veins is diagnosed, blood tests for coagulation problems (hypercoagulability) are done which will both identify predisposing clotting disorders as well as serve to monitor the levels of anticoagulation medications used to dissolve the clot(s) or prevent their extension.