Abstract
There are various methods for lumbar venography, depending upon the infusion route of the contrast medium. The author performed studies on lumbar venography using the Seldinger technique, concerning which no detailed report had yet been published.
Prior to applying the Seldinger technique for lumbar venography to clinical cases, an experimental study was carried out in 28 cadavers to ensure the accuracy of the insertion of Seldinger's needle into the femoral vein and the catheterization of the ascending lumbar and presacral veins. The direction and distribution of the veins were then anatomically elucidated and therewith classified. Subsequently a clinical study was performed on 104 patients with suspected lumbar disc herniations.
1) The morphology of the direction of the femoral veins were classified into Types 1, 2, and 3 based on the relation of the femoral vein to the femoral artery.
2) Numerous variations were observed in the branching pattern of the ascending lumbar veins and they were classified into Types 1, 2 and 3 on the right side, and Types 1 and 2 on the left side.
3) There were almost no variations in the branching patterns of the presacral veins.
4) Four types of catheters were designed based on the findings obtained from the abovementioned experimental study.
5) Lumbar venography by the Seldinger technique was performed in 104 patients with suspected lumbar disc herniations. Sixty eight patients out of these were examined with venography, myelography and operative exploration. It was found that the diagnostic accuracy of venography was 94%. Discrepancies between the venogram and the operative findings were observed in cases of recurrent lumbar disc herniations. (Cases with previous lumbar disc surgery).
6) In venography at the L 5--S 1 level, better roentgenograms were obtained by catheterizing the presacral vein rather than the ascending lumbar vein.
7) By comparison with the findings in exploratory surgery, it was found that the diagnostic accuracy of venography was far superior to that of myelography at the L 5-S 1 level, although there was no difference between the accuracy of venography and myelography at the L 4-L 5 level.
8) Lumbar venography by the Seldinger technique is an extremely useful auxiliary diagnostic procedure when myelography findings are in disagreement with clinical findings.
