62 year old female correctly diagnosed over 15 years ago with pelvic congestion syndrome (PCS). The patient was offered a hysterectomy which is not the first line of treatment for this condition. She declined. The patient was identified by her chiropractor as have PCS and was referred for treatment. In this patient, the primary cause of PCS was compression of the left renal vein which, when asymptomatic, is referred to Nutcracker Phenomena. In addition, the patient had findings of iliac vein compression. This patient is interesting as the decision making for best treatment options is complex.
Painful varicoceles interfering with high school athletics
65 year old cyclist with extensive superficial and deep venous incompetence and venous ulceration
94 year old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout.