Descending Venography

Abstract

Patients with chronic venous insufficiency may have a combination of problems. The veins in the lower extremity can be affected by post phlebitic changes, obstruction, venous valvular incompetence or any mixture of these. Correct medical and/or surgical treatment hinges on the accurate assessment of the venous system. Complete studies of the lower extremity should incorporate ascending and descending venography as well as the clinical presentation. The methods described above easily enable one to achieve this accuracy with a minimal of time and discomfort to the patient. The incidence of primary venous valvular incompetence, may be higher than first anticipated and only by performing descending venography will this cause chronic, venous insufficiency to be unmasked. When employed in the appropriate patient, descending venography is an invaluable asset to diagnosis and ultimate treatment.

Vein Valve Transplantation

“…With a Valsalva maneuver, 10 mL of dye is injected and the grade of venous insufficiency is determined according to Kistner's classification. 11 Grade 0: no reflux Grade 1: reflux to the first valve Grade 2: reflux to the upper thigh Grade 3: reflux to above the knee Grade 4: reflux to below the knee Immediately following venography, ambulatory venous pressures, including return times, are determined. Only 40% of patients with abnormal ambulatory venous pressures have grade 3 or 4 venous insufficiency, whereas abnormal return times were present in 75% of cases with severe venous insufficency.…”

Five years' experience with vein valve transplant

“…To evaluate patients with VIS, a history, physical examination, and noninvasive testing should first be done. Then, if indicated, venous pressure measurements and descending and ascending venography [5] should be used to diagnose the condition quantitatively as suggested by the preliminary test. In addition, we are currently refining a technique to measure long-term (24-hr) ambulatory venous pressure, known as the Dynamic Leg Evaluation System (DyLES), which has been shown to be both valid and reliable [4].…”