Observations on Venography of the Lower Extremities

The observations on venography of the lower extremities recorded in this paper have been made from a series of approximately 130 cases and cover a period of a year. Interest in the subject was stimulated by reports of cases of acute thrombophlebitis by Fine and Sears and by Homans and Dougherty, but the work was undertaken without any preconceived ideas obtained from the literature. Bauer's fine monograph was not seen until several months later. Acute thrombophlebitis is not as yet thoroughly investigated in most places. The aid to be obtained from venographic procedures both for diagnosis and as an indication for treatment is not sufficiently appreciated. Many of our cases were investigated because of chronic conditions involving the legs. Since a number of our observations are dependent upon technical factors, a brief report of the manner in which the work was done will be given. It is our belief that adequate roentgen examination involving physiological processes cannot be made with a single film. Physiological changes in many parts of the body are rapid and somewhat variable. The ideal method for the study of such processes would be by moving pictures if this were technically feasible. Photo-roentgen devices may make such studies possible, but these are still out of the question for most of us. The next best procedure seems to be a serial method, consisting in multiple film studies made over varying time intervals. The passage of dye through the venous and arterial circulation is rapid. In our own experience, the interpretation of single films is tricky and frequently misleading. Fortunately, in the lower extremity, with the patient supine, the dye passes through the venous circulation slowly enough to be demonstrated in multiple exposures from the region of the ankle to the thigh and including the first portion of the external iliac vein. This will be brought out more fully later. For our studies we have used diodrast, the patient being given the Dolan mouth test prior to injection. Twenty cubic centimeters of the dye are injected slowly over a period of approximately two minutes through a very small needle into a small vein on the dorsum of the foot or below the internal or external malleolus.