J Korean Soc Radiol.  2011 Jul;65(1):61-68. 10.3348/jksr.2011.65.1.61.

Venogram of the Upper Extremity Using the Tourniquet Technique for the Evaluation of Central Vein Patency: A Comparison to Conventional and CO2 Venogram

• Lee SA
• Chung HH
• Lee SH
• Cha SH
• Je BK
• Seo BK
• Kim BH
• Seo HS

• KMID: 1443494
• DOI: http://doi.org/10.3348/jksr.2011.65.1.61

Abstract

PURPOSE
To compare the tourniquet technique (TT) with the conventional venogram (CV) and the carbon dioxide venogram (CO2V) for the evaluation of central vein patency of the upper extremity.
MATERIALS AND METHODS
CO2V, TT, and CV were performed on 100 upper extremities prior to an arteriovenous fistula operation. The central vein was divided into four segments. The best image of the venograms for each segment was chosen as a reference, and the venogram techniques for each segment were graded from 1 (invisible) to 5 (excellent) compared with those of the reference image. The grades of the various venogram techniques at each segment of the vein were compared statistically.
RESULTS
For the SVC segment, the mean grades of CO2V, TT, and CV were 4.32, 3.60, and 2.45, respectively. TT is statistically superior to CV but inferior to CO2V. On the brachiocephalic vein, the mean grades of CO2V, TT, and CV were 4.41, 4.37, and 2.77 and were 4.81, 4.85, and 3.78 for the subclavian vein and 4.75, 4.93, and 4.57, respectively, on the axillary vein. On these segments, TT was statistically superior to CV, but no difference was noted with CO2V.
CONCLUSION
TT is superior to CV in every segment of the central vein and presents similar values to those of the CO2V, except for the SVC.

MeSH Terms

Arteriovenous Fistula
Axillary Vein
Brachiocephalic Veins
Carbon Dioxide
Contrast Media
Subclavian Vein
Tourniquets
Upper Extremity
Veins
Carbon Dioxide
Contrast Media

Figure

• 

  Fig. 1 Venogram of the right central vein in a 48-year-old man. Tourniquet technique (B) and CO2 venogram (C) demonstrate the patency of the central vein very well, as opposed to the right brachiocephalic vein and superior vena cava (SVC), which are invisible on conventional venogram, and the subclavian and axillary veins are similarly poorly visible (A). Image qualities of the tourniquet technique and CO2 venogram are quite similar, but a mild degree of pseudostenosis is shown in the right axillary vein using the CO2 venogram (arrow) (C).

• 

  Fig. 2 Venogram of the left central vein in a 65-year-old man. Because the left brachiocephalic vein was poorly visible by conventional venogram (A), it was uncertain whether true stenosis was present or whether it was the result of slow flow of the iodine contrast material due to its high viscosity. However, the tourniquet technique (B) and CO2 venogram (C) demonstrate patency of the left brachiocephalic vein.

• 

  Fig. 3 A venogram of the left central vein in a 72-year-old woman having situs inversus. Conventional venogram (A) shows a poorly visible left brachiocephalic vein, which is not clear whether or not true stenosis is present. Nevertheless, the tourniquet technique (B) demonstrated not only an actual narrowing of the brachiocephalic vein (black solid arrow), but also combined collateral veins (dotted arrow). The CO2 venogram (C) also showed an actual narrowing of the left brachiocephalic vein (empty arrow), but the collateral veins were not visible.

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