Phlebographic anatomy

Phlebographic anatomy

Several opacification techniques can be used to visualize all or part of the venous system of the lower limbs.

Ascending phlebography

This is performed by percutaneous puncture of a vein of the dorsum of the foot with the patient in the supine position on a large-cassette serial radiography apparatus. A series of tourni­ quets is applied at different levels (malleoli, knees, proximal thigh), essentially to reveal deep vein thromboses’ of the iliac, femoral, popliteal and leg veins. However, the gastrocnemial, soleal and profunda femoris veins are not opacified by this technique.

Figure 4 : Lower limb perforators shown by selective varicography with tourniquets.
Figure 4 : Lower limb perforators shown by selective varicography with tourniquets.

Dynamic retrograde femoral phlebography

Performed in the standing position, this examination can demonstrate absence of deep vein valves and can opacify an incompetent saphenous system.

Selective varicography

Several selective varicography techniques are used to visualize varicose veins and their blood supply (Figure 4).

Their invasive nature and the need to inject a contrast agent which modifies hemodynamic conditions have gradually led these examinations to be replaced by ultrasound techniques.

However, several territories can only be pre­cisely investigated by dynamic phlebography and varicography. These techniques were used to define the pathophysiology of the gastrocne­ mial veins and were also used to study anatomi­ cal variants of the short saphenous vein and associated reflux, as well as the convection of the tributaries of the arch of the long saphenous vein with veins derived from the pelvis.

Further reading

Almen T., Nylander L. Serial phlebography of the normal lower limb during vascular contraction and relaxation. Acta Radiol, 1962, 57: 264.
Picard ID., Pellerin M. La phlébographie des membres et des systèmes caves. Expansion Scientifique Française, Paris, 1985.
Perrin M. L’apport de la phlébographie dans le traitement chirurgical de l’insuffisance veineuse chronique des membres inférieurs. Phlébologie, 1988, 41: 115-34.
Perrin M., Bolot J.E., Genevois A., Hiltbrand B. La phlébographie poplitée dynamique. Phlébologie, 1988, 41: 429-40.