The deep venous consensus update session at the 2023 Charing Cross (CX) International Symposium (25–27 April, London, UK) covered a range of key topics in the field, including issues associated with pelvic venous lesions.
The session opened with a series of presentations on the pelvic veins, starting with one from Kathleen Gibson (Lake Washington Vascular, Bellevue, USA) on optimal work-up before intervention for patients with pelvic venous reflux. “This is going to be one of these talks that is full of my opinions and not data,” she said in opening, explaining that this is an area in which there is, as yet, no consensus.
Among Gibson’s conclusions was the message that patient history and presentation are important in patients with pelvic venous reflux, urging audience members to “treat the patient, not the imaging”. On the topic of imaging, however, she did note that duplex ultrasound, cross-sectional imaging and venography/intravascular ultrasound “all have important diagnostic roles” and that confirmatory imaging is “very important” to make a definitive diagnosis prior to treatment.
Subsequently, Aleksandra Jaworucka-Kaczorowska (Jaworuccy Center for Surgery and Dentistry, Gorzow Wielkopolski, Poland) outlined three edited cases on ‘bottom-up’ treatment for pelvic origin varicose veins. She explained that, in her experience, ‘top-down’ treatment does not give good results and that very often multiple embolisation sessions are required. The results of ‘bottom-up’ treatment, on the other hand, she has found to be good. This is also a less invasive treatment, she pointed out, adding that it can be repeated if required and is cost-effective.
Moderator Manj Gohel (Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK) noted that the presenter was able to offer a “unique perspective” on this topic due to the fact she is a trained gynaecologist, and, in the discussion following her presentation, Jaworucka-Kaczorowska shared some insights from her practice with an audience of vascular surgeons.
Later in the session, Karen Breen (Guy’s and St Thomas’ NHS Foundation Trust, London, UK), a consultant haematologist, spoke on the implications of pelvic venous and iliac venous interventions of future pregnancies. She advised delegates to discuss acceptable forms of contraception with these patients and highlighted the importance of pre-conception counselling. Breen also underscored the significance of a multidisciplinary team approach “where practical” and stressed that “more data on outcomes are needed”.