OPTIMIZATION OF ASCENDING PHLEBOGRAPHY OF THE LEG FOR SCREENING OF DEEP-VEIN THROMBOSIS IN THROMBOPROPHYLACTIC TRIALS

Purpose: Comparison of 2 phlebographic techniques in achieving adequac y of deep venous filling. Material and Methods: Sixty consecutive pati ents with a clinical suspicion of deep vein thrombosis (DVT) were exam ined by 2 different techniques, A according to GREITZ and B according to LEA THOMAS. All deep veins were scored according to a protocol as D VT, normal or inadequate. Venous evaluability and DVT rates were compa red. Bilateral phlebograms according to the A-technique from 92 asympt omatic 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 evaluable 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 t he gastrocnemius muscular (82% vs 38%), anterior tibial (85% vs 43%), and deep femoral (28% vs 18%) veins. No significant difference was fou nd 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 asymptom atic patients were adequate. Conclusion: The A-technique resulted in b etter venous opacification and would seem to be a more suitable screen ing method for asymptomatic persons.