A venogram is an X-ray procedure that can be both diagnostic and therapeutic. A venogram detects venous narrowing, obstruction, or blood clots using X-rays taken during the injection of a contrast agent (iodine dye). The procedure provides critical information that helps your vascular surgeon determine the best treatment options for conditions such as deep vein thrombosis (DVT), chronic venous insufficiency, iliac vein compression (May-Thurner syndrome), pelvic congestion syndrome, post-thrombotic syndrome, and unexplained leg swelling.
Venograms are typically performed while you are sedated. The procedure may last 30 minutes or longer depending on the complexity of the venous blockage and whether treatment is performed at the same time.
Venogram Procedure
A venogram is commonly performed under sedation with the use of local anesthesia.
The procedure usually begins with a needle inserted into a vein, often in the groin (femoral vein).
After venous access is established, catheters (thin tubes) and wires are carefully guided through the venous system to the area of concern. Contrast dye is then injected into the vein while X-ray images are taken. These images allow your vascular surgeon to visualize blood flow, detect blood clots, and evaluate areas of compression or obstruction.
If significant narrowing or blockage is found, treatment may be performed during the same procedure.
Common Treatments Performed During a Venogram
Balloon Venoplasty
Balloon venoplasty is used to open narrowed veins. Guided by X-ray imaging, your vascular surgeon navigates a wire through the area of narrowing and introduces a balloon catheter. Once positioned across the narrowed segment, the balloon is inflated to widen the vein and improve blood flow. The balloon is then deflated and removed, and contrast dye is injected again to evaluate the result. Treatment is considered successful when blood flow improves and the narrowing is significantly reduced.
Venous Stent Placement
In some cases, a stent may be placed to keep a compressed or narrowed vein open. This is commonly performed for conditions such as iliac vein compression (May-Thurner syndrome) or chronic venous obstruction following DVT.
Venous stents are permanent implants designed to support the vein and maintain adequate blood flow. These stents are typically made from flexible metal alloys that expand to a preset size once deployed. They are engineered to resist compression from surrounding structures and allow normal movement without kinking.
Catheter-Directed Thrombolysis or Thrombectomy
If a large or acute blood clot (deep vein thrombosis) is present, specialized catheter-based treatments may be used to dissolve or remove the clot. This can help relieve symptoms such as severe leg swelling and pain while reducing the risk of long-term complications like post-thrombotic syndrome.
When is a Venogram Recommended?
Your vascular specialist may recommend a venogram if you experience:
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Unexplained leg swelling
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Chronic leg pain or heaviness
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Recurrent deep vein thrombosis
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Suspected iliac vein compression
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Pelvic pain related to pelvic congestion syndrome
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Non-healing venous ulcers
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Symptoms that persist despite prior treatment
If surgical treatment is determined to be a better option, your vascular surgeon will obtain any additional imaging needed to plan the appropriate intervention before concluding the venogram.