38 year old female with deep venous thrombosis 14 years ago while on birth control pills. Second DVT shortly after discontinuing anti-coagulation. Hematologic work up showed the patient to have Protein S deficiency. Patient suffered with severe post thrombotic syndrome eventually resulting in venous ulceration 8 years ago. Patient suffered with a chronic ulcer that was eventually healed after venoplasty of the femoral and popliteal veins.
Nutcracker syndrome is one of the causes of secondary pelvic congestion syndrome.
Recurrent left testicular pain after inadequate embolization of the proximal left testicular vein
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.