Our approach to venograms
At NYC Surgical Associates, we utilize venograms in a very specific way that other surgical practices do not. We have specialized our techniques to specifically determine and correlate a patient’s symptoms with potential disease processes that we can utilize minimal intervention techniques to address and rectify.
What is a venogram and when are they needed?
A venogram is a diagnostic test that is used to image the larger veins from the groin up until the lower chest. The reason this test is being done, most often is because something was seen to be abnormal with ultrasound scanning that warranted further workup based on symptoms and anatomy.
Ultrasound scanning is excellent for imaging the legs, and sometimes the kidney. It also gives us a view of the pelvis and anatomy in most patients but this view is not adequate to make a firm diagnosis in most, because the abdominal organs are in the way.
With a venogram, we can see clearly typically almost everything we need to see, and often treat some things at the same time if needed in a very minimally invasive fashion without downtime. Most often, we will do the initial venogram with the patient awake, so that they may be involved in the decision process, and we can show them their anatomy, and why they feel the way they do.
In addition, by having a full assessment of your venous anatomy, not one just limited to the legs, we are able to prevent complications and recurrence causes of treating just the legs. Often, we uncover things that have been longstanding causes of patient’s symptoms but they have never been attributed to veins. We are able to also identify common causes of major blood clots and potentially treat them prior to any major surgical undertaking, especially abdominal surgeries, which are high risk for clots.
What are some of the things that can be diagnosed with a venogram?
During a venogram, there are several things that can be identified and treated. Some of them warrant treatment at the same time, some of them deserve a more comprehensive discussion about options, indications for treatment, and whether treatment is needed at all.
The two main things we see are blood pooling in veins, narrowing (stenosis) of the veins, both of these things existing together, and uncommonly, nothing at all abnormal.
Simply put, the ultrasound is a good screening test for problems, and a venogram helps us identify them clearly, and potentially treat them if needed.
You should understand before you have your venogram, that the venous system is a frequent site of congenital variants. In fact, venous variants are amongst the most common site of differences amongst all of us. Most of these variants do not require treatment, and most of them should not cause you to worry at all. It’s our job as physicians to identify any issues, discuss with you to assess whether any of them could be causing issues, and treat appropriately.
We want you to be aware of this fact, so that if you see an “abnormality” on the venogram, as you are often involved with the process, you don’t get worried unnecessarily. Your physician will discuss things with you when needed, and you are always free to ask questions. In fact, we welcome that. It has been our experience that educated patients are always the most satisfied patients.
Remember, any and all conditions we will find are typically things you have had for a very long time, and you may have them for a while longer without major consequences. None of them deserve undue worry. Sometimes, patients tend to panic with so much information being presented to them, but we are here to help you understand it, and make the right decision, which is most often unique to eachpatient.
Why can I need more than one venogram?
Depending on what is found, and where, we may need to do another study at a later date for access at a different site of the body, or the use of different equipment, such as intravascular ultrasound (IVUS) in order to make the right decision. Often, treating other things found deserves an in detail discussion of the various options before something is actually done, and we have found this discussion is not best had while the patient is in the operating room.
One of the nice things about venous disease, is that it is chronic in nature, meaning very few issues are an emergency, or even urgent, giving you time to do some research, for us to collect all of the information we can, and to help you make a non-pressured, appropriate decision that is right for you.
What are the risks of doing a venogram?
With any medical procedure, there is a theoretical risk of bleeding as well as infection. In addition, whenever endovascular procedures are performed, such as a venogram, unique but very rare risks include the possibility of malposition or movement of devices, as well as damage to blood vessels and organs. The risk of clots is possible as well, although most of what we do is done to prevent clots, especially dangerous ones.
Contrast dye used in the study can sometimes but rarely cause allergic reactions ranging from itching to more severe reactions. Let your physician know if you have an iodine allergy or an allergy to contrast media in the past, or a diagnosed blood clotting disorder or deep vein thrombosis in the past. In our experience at NYC Surgical our complication rate is far below that of most major academic institutions, far below the national average of less than 1 percent. Overall, the risk of these procedures is far lower than conventional surgery, but still present, and must be discussed.