Contrast venography

Radiographic contrast studies are the most accurate and reliable method for diagnosis of VTE. Contrast venography allows visualization of the entire venous system in the lower extremity and abdomen. Pulmonary angiography allows visualization of the pulmonary arteries. The diagnosis of VTE can be made if there is a persistent intraluminal filling defect on multiple x-ray films. 

Figi 1.43 Contrast venography of both subclavian veins in a patient with superior vena cava syndrome. He carried a monocatheter pacing system on the left (implanted 4 years earlier) and had two abandoned leads on the right (the pacemaker, implanted 21 years earlier, had been removed from the right pocket due to local infection). Subocclusive obstruction between the right subclavian and innominate veins (a). Total obstruction is visible in the first tract of the superior vena cava arrow). Occlusive obstruction visible in the middle tract of the left subclavian vein h) arrow)... 

Fig. 4.25 Contrast venography of the larger axillary vein with a smaller cephalic vein draining into it at a right angle. (From Belott PH, Reynolds DW. Permanent pacemaker and cardioverter defibrillation implantation. In Ellenbogen KA, Kay N, Wilkoff BL, eds. Clinical cardiac pacing and defibrillation, 2nd ed. Philadelphia WB Saunders, 2000, with permission.)...

LV pacing has undergone considerable evolution in its short history. Initially, pacemaker electrodes were placed in the coronary sinus using a stylet-driven technique. This has evolved to the currently acceptable use of a guiding catheter contrast venography for either a stylet-driven or some form of guidewire-assisted placement. 

Higano ST, Hayes DL, Spitteh PC. Facihtation of the subclavian-introducer technique with contrast venography. PACE 1992 15 731. 

Ramza BM, Rosenthal L, Hui R, et al. Safety and effectiveness of placement of pacemaker and defibrillator leads in the axillary vein guided by contrast venography. Am J Cardiol 1997 80 892. 

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