Upper limb venography is a radiographic examination of upper limb veins in which contrast is injected into the veins of wrist to visualize the abnormalities of the forearm and arm veins.

Indication 

  • Obstruction in veins due to the blood clot
  • Deep vein thrombosis
  • Evaluate deep vein valves
  • Venous malformation
  • Swelling in upper limb

Contraindication 

  • Hypersensitivity to contrast
  • Blood clotting disorder
  • Suspected pregnancy
  • The patient have asthma and diabetes

Equipment

  • Fluoroscopy unit with tilting table 
  • Contrast
  • Butterfly needle
  • Antiseptic solution
  • Syringes
  • Tourniquet

Patient  preparation

  • The patient should not eat or drink after midnight.
  • Patient KFT reports must be reviewed prior to the examination.
  • Ask the patient to stop taking anticoagulants before the exam.
  • Describe the whole procedure to the patient.
  • Ask the patient to remove clothing and wear a hospital gown. 

Procedure

  • Place the patient in the supine position.
  • Clean the area of the patient foot with an antiseptic solution.
  • A tourniquet is applied above the ankle to stop blood flow.
  • An intravenous line is inserted into the patient’s arm and sedative medication is given through the line to make the patient relax.
  • A butterfly needle is inserted into the superficial vein of the wrist then 40 ml of contrast is injected by hands at the rate of 2-4 ml per second.
  • The first series of spot films of the forearm is taken immediately after contrast media administration.
  • Ask the patient to perform the Valsalva maneuver to delay the transit of the contrast media.
  • The second film of the arm is taken after a few seconds in a relaxing Valsalva maneuver.
  • In this position, the veins of the arm the basilic, and the cephalic are filled with contrast media.
  • Several films of the arm and the shoulder region are taken in anterior-posterior and lateral projection.
  • At the end of the procedure, the needle should be flushed with saline to avoid phlebitis.
  • After completion of the examination, the butterfly needle is removed, and the dressing is applied to the puncture site of the foot.

Aftercare

  • Keep the patient under observation BP, heart rate injected site swelling and other vital signs should be monitored.

Interpretation

  • If the venogram shows blood clots or blockage in the veins, special medicine may be given to dissolve the clot or a balloon angioplasty may be performed.
  • To widen the vessels and improve blood flow during the angioplasty a metal stent may be placed by the surgeons.