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BackTable / VI / Podcast / Episode #337

Management of Vulvar Varices

with Dr. Brooke Spencer

In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Brooke Spencer about management of pelvic venous disease, endovascular therapies for pelvic varices, and important considerations for treating patients with complex and chronic pain.

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Management of Vulvar Varices with Dr. Brooke Spencer on the BackTable VI Podcast)
Ep 337 Management of Vulvar Varices with Dr. Brooke Spencer
00:00 / 01:04

BackTable, LLC (Producer). (2023, June 26). Ep. 337 – Management of Vulvar Varices [Audio podcast]. Retrieved from

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Podcast Contributors

Dr. Brooke Spencer discusses Management of Vulvar Varices on the BackTable 337 Podcast

Dr. Brooke Spencer

Dr. Brooke Spencer is an interventional radiologist at the Minimally Invasive Procedure Specialists (MIPS) group in Denver, CO. View Dr. Brooke Spencer's full profile here.

Dr. Aparna Baheti discusses Management of Vulvar Varices on the BackTable 337 Podcast

Dr. Aparna Baheti

Dr. Aparna Baheti is a practicing Interventional Radiologist in Tacoma, Washington.


Dr. Spencer serves as the CEO and medical director of Minimally Invasive Procedure Specialists in Denver, CO. Her patients commonly get referred from OB/GYNs for chronic pelvic pain that is refractory to laparoscopic surgery and undiagnosed. She notes that collaborative relationships with women's health specialists and pelvic pain physical therapists are necessary for adequate patient outreach. Classifying cases by the location and nature of the vessel abnormality (i.e. compressive, obstructive, varicose, reflux, congenital) allows her to think about the best treatment for each patient. Targeting proximal veins can improve back and groin pain, dyspareunia, and heavy periods. Iliac vein stenting can improve compressive symptoms 50% of the time. On the other hand, isolated labial pain is best treated by directly targeting labial varices. Perineal ultrasound is a helpful way to locate some varicosities, but Dr. Spencer prefers MRI and digital subtraction venography to get a comprehensive venous picture and correlate symptoms with imaging.

Next, the doctors discuss embolization and foam sclerotherapy. Through her experience, Dr. Spencer has seen sclerotherapy work better in varices with slower outflow and coil embolization work better for varices with more rapid flow. She prefers oversized floppy coils to minimize the risk of migration. With both treatments, there can be significant insurance barriers. It is important to utilize preauthorization specialists and be aware of what the patient’s insurance will cover, in order to better frame a conversation about treatment options.

After the procedure, maximal pain relief can be achieved anywhere between 3 to 6 months. During this period, it is important to counsel patients over adjunct therapies such as pelvic floor therapy, steroids, and puncture aspiration to remove trapped blood. Overall, Dr. Spencer wants IRs to keep in mind that the chronic pain population has faced many misdiagnoses and insurance barriers, so they might harbor mistrust of the healthcare system. It is crucial to acknowledge their feelings and understand their anatomy in order to manage their expectations.


Pelvic Guru:

Efficacy of Endovascular Treatment for Pelvic Congestion Syndrome:

International Pelvic Pain Society:

“The Way Out” book:

Disclaimer: The Materials available on are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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