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In two studies 267 consecutive patients with suspected leg vein thrombosis were examined by an 125I-fibrinogen uptake test (125I-FUT) and by phlebography. The ionic meglumine calcium metrizoate (Isopaque Cerebral) was used as the phlebographic contrast medium in 161 patients, and the non-ionic metrizamide (Amipaque) was used in 106. In these two groups 47 and 41 patients, respectively, had normal phlebograms as well as an initially normal 125I-FUT. After phlebography 29 (62%) of the patients who had received meglumine metrizoate had a significant rise in fibrinogen uptake, while such a rise was not found in patients examined with metrizamide. Repeat phlebography showed fresh deep-vein thrombosis in seven of the nine patients with increased uptake, indicating a complication rate of 48%. Consequently, we now use metrizamide in leg phlebogrphy; because of its expense a radioisotope test is employed as a screening procedure.

In two studies 267 consecutive patients with suspected venous thrombosis were examined 125I-fibrinogen uptake test at phebography. In 161 patients meglumine metrizoate (Isopaque Cerebral) and in 106 patients metrizamide (Amipaque) was used as contrast medium. The quality of the examinations was equal in the two groups. During the examinations most of the patients examined with meglumine metrizoate had symptoms from the calf described as a cramp-like pain. Only few of the patients examined with metrizamide had such symptoms. In the two groups 47 patients examined with meglumine metrizoate and 41 examined with metrizamide had normal phlebography as well as initially normal 125I-fibrinogen uptake test. After phlebography, 29 of the patients in the first group had a significant rise in fibrinogen uptake while such a rise was not found in patients from the second group. Rephlebography showed fresh deep vein thrombosis in 7 out of 9 patients examined with meglumine metrizoate indicating that thrombosis could be provoked in as many as about half the patients with this high osmolar contrast medium. We have now used metrizamide in about 400 patients without any side-effects.

A new, non-ionic low osmolar contrast medium, iohexol 240 mg I/ml, has been tested in a randomized double blind parallel investigation versus meglumine-Ca metrizoate 200 mg I/ml. The study was performed to evaluate the suitability of the contrast medium in phlebography. No post-phlebographic complications were seen in the 24 patients examined with iohexol 240 mg I/ml or in 8 patients examined with iohexol 300 mg I/ml. In the 19 patients examined with metrizoate 200 mg I/ml, 7 had a post-phlebographic thrombotic complication (37%). The radiographic image quality was not significantly different between the two contrast media, neither were the immediate side effects during contrast injections. It has thus been shown that iohexol is a suitable contrast medium in phlebography of the lower limb and that it is preferable to conventional contrast media.

In 20 of 61 patients with initially normal phlebograms, uptake of 125I-labelled fibrinogen subsequently increased. In 4 (7%) cases, independent examinations (pulmonary scintigram or a new phlebogram) demonstrated a thromboembolic or thrombotic process. These results suggest that thrombosis and embolism may be caused by phlebography.

The side-effects at phlebography of the lower limb were evaluated using an ionic contrast medium, meglumine-metrizoate, and a non-ionic contrast medium, metrizamide. A post-phlebographic accumulation of 125I-fibrinogen was found in 6 patients examined with meglumine-metrizoate indicating a post-phlebographic thrombosis. Ten patients were examined with metrizamide with no post-phlebographic increase in 125I-fibrinogen uptake. Though the groups are small the difference is statistically significant at the 0.2 per cent level.

In two studies 267 consecutive patients with suspected leg vein thrombosis were examined by anI-fibrinogen uptake test (I-FUT) and by phlebography. The ionic meglumine calcium metrizoate (Isopaque Cerebral) was used as the phlebographic contrast medium in 161 patients, and the non-ionic metrizamide (Amipaque) was used in 106. In these two groups 47 and 41 patients, respectively, had normal phlebograms as well as an initially normalI-FUT. After phlebography 29 (62%) of the patients who had received meglumine metrizoate had a significant rise in fibrinogen uptake, while such a rise was not found in patients examined with metrizamide. Repeat phlebography showed fresh deep-vein thrombosis in seven of the nine patients with increased uptake, indicating a complication rate of 48%. Consequently, we now use metrizamide in leg phlebography; because of its expense a radioisotope test is employed as a screening procedure. [ABSTRACT FROM AUTHOR]