Images in Cardiovascular Medicine Catheter-Induced Venous Spasm

igital subtraction venography provides invaluable an-atomic and hemodynamic information about the ve-nous system, particularly in patients with congenital venousanomalies.An 18-year–old male patient with congenital phlebectasiaof the superficial and deep veins of the left calf associatedwith anomalous veins presented with pain and heaviness.Prior to percutaneous occlusion of the ectatic veins, sono-graphic image demonstrated a patent popliteal vein (Figure1). Multiple venous accesses were obtained to study the lowerextremity venous drainage. Antegrade venography via ananterior tibial vein and retrograde venography via left femoralvein demonstrated ectasia and incompetence of the posteriortibial veins with reflux (Figure 2), which were embolizedwith coils. The popliteal and anterior tibial veins werenormal. The incompetent posterior veins were embolizedwith coils. Postembolization venography demonstratedsmooth narrowing of the popliteal vein (Figure 3). Thispersisted even after retracting the catheter into the femoralvein. Differential considerations to explain this finding in-cluded venous spasm, external compression secondary toperivenous hematoma, and, less likely, thrombosis. Sonogra-phy showed the walls of the vein contracted around the