What is the role of direct contrast venography in the diagnosis of varicose veins and spider veins (telangiectasia)?

Updated: Sep 25, 2020
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Direct contrast venography is the most labor-intensive and invasive imaging technique. In most centers, it has been replaced by duplex ultrasonography for routine evaluation of venous disease, but the technique remains extremely useful for difficult or confusing cases. [6]

An intravenous catheter is placed in a dorsal vein of the foot, and radiographic contrast material is infused into the vein. If deep vein imaging is desired, a superficial tourniquet is placed around the leg to occlude the superficial veins and force contrast into the deep veins more quickly.

Assessment of reflux by direct contrast venography is a difficult procedure that requires passing a catheter from ankle to groin with selective introduction of contrast material into each vein segment.

Nearly 15% of patients undergoing venography for detection of deep venous thrombosis (DVT) develop new thrombosis after contrast venography. The incidence of contrast-induced DVT in patients who undergo venography for diagnosis and mapping of varicose veins is not known.

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