Iliofemoral phlebography in pulmonary embolism

Iliofemoral venous thrombosis is a common condition which, in the great majority of patients, occurs primarily in the iliofemoral segment and not as a result of proximal propagation of distal thrombus. In addition to the common femoral and external iliac veins the common iliac is an important primary site of thrombosis. Non-occlusive iliofemoral thrombus is common and is usually symptomless and unsuspected. Whether clinical signs are present or not iliofemoral thrombosis is frequently bilateral. Pulmonary embolism of a degree likely to endanger life occurs only from the iliofemoral segment, and thrombus there constitutes a serious threat to the patient. Iliofemoral phlebography is the only accurate method of examining these veins and should be carried out as a matter of urgency in patients who have a history of pulmonary embolism or who have clinical evidence of iliofemoral thrombosis or of persistent or recurrent peripheral deep vein thrombosis. Direct puncture of the common femoral vein under local anaesthesia is the method of choice and general anaesthesia should be avoided if possible.