Prospective study of safety of lower extremity phlebography with nonionic contrast medium

BACKGROUND: Lower extremity deep venous thrombosis (DVT) following high osmolar ionic contrast phlebography has been reported to vary between 9% to 31%. The purpose of this study was to determine the incidence of minor and major adverse reactions and postphlebographic DVT when using nonionic contrast (iopamidol), PATIENTS AND METHODS: One hundred fifty-seven patients with clinically suspected DVT were studied prospectively, One hundred eleven patients had prephlebography duplex ultrasound, and 102 patients were examined in the vascular laboratory for delayed side effects 1 week after phlebography, The presence of phlebography-induced DVT was assessed using color duplex ultrasound. The mean amount of contrast used was 102 mt. RESULTS: Minor adverse reactions, including nausea, local pain, and dizziness, occurred in 11 (7%) of 157 patients; however, no major complications or postphlebographic DVT was found in the 102 patients who underwent postphlebography duplex ultrasound, Phlebography and pre- and postphlebography duplex ultrasound showed no acute DVT in 70 patients, The maximum hypothetical true rate of major complications tie, postphlebography DVT) that would result in no detectable events in a population of 102 patients with follow-up (for a probability of P <0.05) is 2.9, CONCLUSIONS: Lower extremity phlebography using nonionic contrast material is safe, with no incidence of postphlebography DVT in our series. Its utilization should be encouraged if duplex ultrasound is not available.