In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews Dr. Neil Khilnani about the management of pelvic venous disorders, focusing on embolization practices for treating conditions such as chronic pelvic pain and pelvic venous syndrome. Dr. Khilnani is an interventional radiologist at Weill Cornell Medicine in New York Presbyterian Hospital.

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SYNPOSIS

Dr. Khilnani discusses the significance of identifying and treating venous disorders in patients with chronic pelvic pain. He emphasizes the need for a comprehensive approach that includes detailed patient history, physical exams, and imaging techniques such as ultrasound, CT, and MRI for accurate diagnosis. The doctors also cover the evolution of embolization techniques, including the use of balloon occlusion and sclerosants and they underscore the importance of addressing underlying venous insufficiencies for effective pain management. Additionally, Dr. Khilnani highlights the interconnectedness of various pelvic symptoms and the potential for embolization to alleviate not just pelvic pain, but also related conditions such as painful bladder syndrome and orthostatic hypotension. The doctors acknowledge the ongoing research and the need for collaboration across specialties to improve patient outcomes in pelvic venous disorder.

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TIMESTAMPS

00:00 - Introduction

04:44 - Pelvic Venous Disease

09:20 - Prevalence of Pelvic Venous Disease

13:54 - Challenges in Communication with Referring Doctors

18:32 - Workup and Diagnosis of Pelvic Venous Disorders

30:08 - Treatment Options and Patient Education

36:19 - Role of Social Media in Patient Support Networks

37:04 - Procedure: From Planning to Execution to Post-Intervention

54:07 - Navigating Difficult Anatomy and Potential Complications

01:02:34 - Future of Pelvic Venous Disorders Treatment: Research and Trials

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RESOURCES

BackTable VI Episode 389 - Pelvic PT: An Introduction for Interventionalists with Ingrid Harm-Ernandes, PT:

https://www.backtable.com/shows/vi/podcasts/389/pelvic-pt-an-introduction-for-interventionalists

BackTable VI Episode 337 - Management of Vulvar Varices with Dr. Brooke Spencer:

https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices

BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 1: Diagnosis and Planning

with Dr. Mark Meissner and Dr. Michael Cumming:

https://www.backtable.com/shows/vi/podcasts/101/pelvic-congestion-syndrome-part-1-diagnosis-planning

BackTable VI Episode 101 - Pelvic Congestion Syndrome Part 2: Technique and Follow-Up with Dr. Mark Meissner and Dr. Michael Cumming:

https://www.backtable.com/shows/vi/podcasts/102/pelvic-congestion-syndrome-part-2-technique-follow-up

A standardized ultrasound approach to pelvic congestion syndrome (Labropoulos et al):

https://pubmed.ncbi.nlm.nih.gov/27799418/

Comparison of Fibered versus Nonfibered Coils for Venous Embolization in an Ovine Model (White et al):

https://pubmed.ncbi.nlm.nih.gov/37105664/

Pelvic Venous Disorders in Women due to Pelvic Varices: Treatment by Embolization: Experience in 520 Patients (De Gregorio et al):

https://www.jvir.org/article/S1051-0443(20)30534-0/abstract

Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency (Smith et al):

https://journals.sagepub.com/doi/abs/10.1177/02683555231219737

The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders:

https://www.jvsvenous.org/article/S2213-333X(21)00071-8/fulltext

Research Priorities in Pelvic Venous Disorders in Women: Recommendations from a Multidisciplinary Research Consensus Panel:

https://pubmed.ncbi.nlm.nih.gov/30857986/

Find this episode on BackTable.com for the full list of resources.