Is a Venogram Needed Before Varicose Vein Treatment?

For those considering varicose vein treatment, one question that still comes up sometimes is, “Do I have to get a venogram before varicose vein treatment?” The reason this question comes up, even though the answer is usually “No,” is that venography used to be the gold standard in medicine to view veins deep down. Therefore, people still talk about venograms in association with varicose vein treatment so people ask about them. However, duplex ultrasound has largely replaced this older technique.

What Is a Venogram?

You’ve probably gotten an x-ray at some point in your life. A venogram is essentially an x-ray of the veins. However, since veins are made of soft tissues, not mineralized hard tissue like bones, a special dye has to be put in the veins in order for the x-ray to take an accurate picture of the veins. The dye has iodine in it which can be picked up by x-ray radiation. If you’ve ever run a pencil over an indented piece of paper to reveal the hidden writing or image, then this is the same concept. The procedure is rather invasive because a thin catheter must be inserted into the vein and then the iodine containing dye must be pumped in continuously or the x-ray will not pick up the image properly. This was a common procedure back in the day when vein stripping was the most common type of varicose vein treatment but it is no longer the gold standard.

What Are the Disadvantages Of a Venogram?

Besides being a rather invasive procedure, there are several other disadvantages, or risks, associated with venograms. First, a fairly large percentage of patients are actually allergic to the iodine containing dye needed to conduct a venogram. Second, in some cases, a venogram has been known to cause good veins to collapse. Third, in a few cases, the iodine dye can actually cause kidney failure, particularly if you are taking certain types of diabetic medications. This is why it is always important to list all your medications, including supplements and over the counter medications, so your doctor can check for any known complications before you undergo the procedure.

The biggest disadvantage to x-rays are they are well known carcinogen. All forms of ionizing radiation causes damage to DNA. While this does not mean you’ll get cancer from one x-ray, every x-ray you get increases your odds of getting cancer. This is why you are asked to wear a lead vest to block the areas where you don’t need the x-ray. It’s also why the technician leaves the room before they actually flood the area with x-rays. If the first x-ray doesn’t turn out well, the next one will increase your risk even more. This is not the case if your doctor has to do more than one duplex ultrasound to see something a second, or even third time.

Cost Is a Consideration As well

While cost is not the most important reason, a venogram is also a very expensive test compared to a duplex ultrasound. The average cost of a venogram of a leg vein is $1,250 to $41,900, with the national average being $18,600. By contrast, the top price for a duplex ultrasound is only $550 and it may only cost a little over $200. Therefore, cost is a rather practical reason why your doctor would not choose a venogram over a duplex ultrasound before varicose vein treatment, unless it truly is necessary.

Is There Ever a Time When a Venogram Would Be Used Instead of Duplex Ultrasound?

Yes, there are times with a venogram is needed even after a duplex ultrasound. However, only an experienced vein doctor, such as those at Metro Vein Centers, can really tell as it really depends on the particulars of a situation. Some cases of deep venous thrombosis may need to be investigated with a venogram in addition to duplex ultrasound. This is particularly true in the deep calf region and sometimes the pelvic region.

There Are Some Added Discomforts For a Venogram As Well

Not everyone reacts well when the iodine dye is added to their veins. For example some people have an uncomfortable flushing sensation, almost like a woman has when she has a hot flash or when some people take a niacin (B3) supplement. Some people also get nauseous and some even end up vomiting. Other side effects to a venogram include headaches, breathing difficulty, itchy skin, and breaking out in hives. Luckily, most people who go in for varicose vein treatment today do not need to get a venogram. Duplex ultrasound, which has largely replaced venograms, does not have side effects except perhaps tickling a little in sensitive areas. If you have additional questions, please feel free to schedule an initial exam with Metro Vein Centers.