I love the “how-I-do-it” posts on SIR Connect. When you train and work within the same system, as I have, exposure to different techniques is limited. SIR Connect reminds us that there are many ways to approach a problem. The SIR Connect forum provides an important setting for less formal and more fluid learning and exchange of ideas to occur.


Will you, or have you, changed your practice patterns based on responses on SIR Connect? Please describe any changes you are considering. Although I have not changed any major practice patterns based on SIR Connect threads, I do feel I have expanded my armamentarium based on the insights of my colleagues across the country.


stent placement should be pursued with caution as it carries risks of stent malposition, thrombosis and migration.


In a case such as this, how important is it to obtain additional subspecialty opinions (transplant, vascular surgery, etc.) prior to treatment? This case is an excellent example of a situation where multidisciplinary consultation is extremely important. The most important role of a physician is to educate the patient on all of the available treatment options to help them make the most informed decision possible. In this disease process, where there is no consensus on optimal treatment and possible treatments span specialties, I encourage patients to consult with different specialists to fully understand what each treatment entails, including the risks and benefits. Additionally, if you proceed with percutaneous management and have an anticipated complication that requires salvage from another specialist, it is prudent to have that specialist informed and on board before you proceed with your intervention in order to limit the time to transition of care.


36 IRQ | WINTER 2024


What specifically prompted you to reach out regarding this case/topic? This patient had sought multiple opinions and, as is common in this disease process, received differing recommendations that caused more confusion than clarity. I offered to cull opinions from the broader IR community through SIR Connect to see if we could find a dominant recommendation to help guide her decision-making.


What ended up being the outcome for this patient? Is there anything you would do differently in retrospect? After evaluating all of the options, this patient ultimately decided that surgical donor nephrectomy was the right decision for her. I do not think I would have done anything differently in this case. I discussed every option with her including the risks, benefits and unknowns surrounding the outcomes of each, and she ultimately made her own, fully educated decision. She trusted me to be honest and have her best interest in mind, not my own.


What post or posts were most valuable to you and why?


Additional commentary: It has been reported that approximately 14.7% of U.S. women of reproductive age will experience chronic pelvic pain (CPP).1


One of


the frequently underdiagnosed etiologies of CPP are pelvic venous disorders (PeVDs). PeVDs in women can have variable presentations including chronic pelvic pain, lower extremity pain and swelling, flank pain, hematuria, and lower extremity/vulvar varicosities. In the past, a variety of terminology such as pelvic venous congestion, May-Thurner syndrome, nutcracker syndrome, etc. have led to imprecise patient diagnosis due to underlying pathophysiology or overlapping signs and symptoms. This in turn has led to confusion surrounding PeVD resulting in diagnostic error and suboptimal outcomes.2


Active efforts are


underway to improve the definition of PeVD, disease classification, optimal diagnostic workup and optimization of endovascular treatment.


The Symptoms-Varices- Pathophysiology (SVP) classification system aims to define groups of patients with similar clinical characteristics of PeVD. There are three domains described in SVP including symptoms, varices and pathophysiology, including subclassification of pathophysiology into anatomic (A), hemodynamic (H)


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