Contrast peripheral phlebography and pulmonary angiography for diagnosis of thromboembolism

At one time, direct intravascular contrast angiography was the standard method for confirmatory diagnosis of venous or pulmonary arterial thromboembolism. Although sensitive and specific, conventional catheter-based contrast imaging is invasive and associated with a risk of phlebitis and thrombosis. These procedures require specialized training and experience in catheter manipulation, as well as specialized vascular imaging equipment. In current practice, less invasive techniques have largely superceded conventional angiography because they can be performed by technologists using widely available, multifunctional apparatus under physician supervision. When results using these newer approaches are inconclusive or impractical, however, catheter-based techniques are still relied on for definitive diagnosis. The purpose of this article is to review the indications, techniques, and interpretations of contrast angiography as applied to venous thromboembolic disease.