Fellows Course: Deep Venous Reflux and Ovarian Vein Treatment

Correlating Symptoms with Anatomic Findings

The presenter stressed taking a detailed history distinguishing pelvic, leg, and flank symptoms before attributing them to iliac, ovarian, or renal vein pathology, noting about 30 percent of patients have primary valvular incompetence rather than post-thrombotic injury or external compression.

Ovarian Vein Treatment and Persistent Recurrence

She described cases where ovarian vein transposition or coil embolization initially relieved symptoms but recurred as collaterals reformed, requiring repeat coiling and stenting, plus cannulation tricks including approaching the right ovarian vein from the jugular using CT landmarks.

Balloon Occluded Sclerotherapy for Internal Iliac Reflux

For isolated internal iliac reflux, she selectively catheterizes the vessel, performs balloon occlusion venography, then injects foam sclerosant through the balloon catheter, using contrast volume as a rough guide for sclerosant needed to fill the refluxing bed.

Stenting Pitfalls and Timing Considerations

She cautioned that oversized iliac stents can cause pelvic or back pain relieved with anti-inflammatories, generally avoids stenting young women before childbearing ends, and noted mechanical thrombectomy devices have reduced the need for TPA in thrombus removal.