iothalamate-meglumine and Venous-Insufficiency

Asymptomatic thrombosis of the subclavian vein is common after placement of indwelling catheters. The sequelae of these thrombi are not known. Investigation is hampered by the requirement for venography for diagnosis; consequently, a noninvasive method of diagnosis would be welcome in this context. We have studied prospectively 32 subclavian catheters to determine the usefulness of duplex ultrasound in diagnosing asymptomatic thrombosis. Sixteen arm venograms were normal and all gave normal duplex scans. No false-positive scans were obtained. Eleven venograms demonstrated nonocclusive mural thrombi. Only three of these were seen with duplex ultrasound. Five totally occlusive thrombi were seen on venography, of which only two were detected with duplex sonography. The three thrombi not found with duplex ultrasound were short proximal venous occlusions. The insensitivity of this technique to asymptomatic subclavian thrombi limits its usefulness as a screening tool.

Topics: Blood Flow Velocity; Catheterization, Peripheral; Catheters, Indwelling; Humans; Iothalamate Meglumine; Phlebography; Prospective Studies; Subclavian Vein; Thrombosis; Ultrasonography; Venous Insufficiency

Peroperative retrograde saphenography was used to study 80 incompetent long saphenous veins (LSV) in 60 patients with primary varicose veins. In 53 limbs presentation was uncomplicated (group A, 40 patients); in 27 limbs there was ulceration (group B, 20 patients). All limbs in group B had a normal deep system as shown pre-operatively by ascending and descending venography. Varicose changes were found in 52 (65 per cent) of 80 LSV; the overall mean length of normal vein seen was 16 cm. The incompetent LSV appears unlikely to be suitable for arterial replacement. All valves identified on operative saphenography above the knee appeared incompetent. In only 9 LSV of group B were there recognizable valves either above or below the knee, significantly fewer than 34 of group A (P less than 0.05). This finding suggests that a deficiency of saphenous valves may contribute to the development of venous ulceration. Hunterian perforators of variable size were seen on 70 saphenograms (87 per cent) passing directly from the LSV to the superficial femoral vein. Stripping of the incompetent LSV will disconnect such perforators from an incompetent system and may thus reduce the incidence of both recurrent varicose veins and persistent ulceration.

Topics: Female; Humans; Iothalamate Meglumine; Male; Middle Aged; Radiography; Saphenous Vein; Varicose Ulcer; Varicose Veins; Venous Insufficiency