Optimization of ascending phlebography of the leg for screening of deep vein thrombosis in thromboprophylactic trials

Abstract

Purpose: Comparison of 2 phlebographic techniques in achieving adequacy of deep venous filling. Material and Methods: Sixty consecutive patients with a clinical suspicion of deep vein thrombosis (DVT) were examined by 2 different techniques, A according to GREITZ and B according to LEA THOMAS. All deep veins were scored according to a protocol as DVT, normal or inadequate. Venous evaluability and DVT rates were compared. Bilateral phlebograms according to the A-technique from 92 asymptomatic patients in a different trial were reviewed to allow comparison with the symptomatic subjects. Results: the A-technique resulted in a significantly higher degree of overall evalu-able patients compared to the B-technique, 95% vs 47%. A vein-by-vein analysis showed that the A-technique was significantly better than the B-technique in filling the gastrocnemius muscular (82% vs 38%), anterior tibial (85% vs 43%), and deep femoral (28% vs 18%) veins. No significant difference was found in the other veins. the DVT rates were 42% and 40% respectively for the A- and B-techniques. About 94% of the phlebograms in the asymptomatic patients were adequate. Conclusion: the A-technique resulted in better venous opacification and would seem to be a more suitable screening method for asymptomatic persons.