I am committed to providing expert, patient-centered treatment for pelvic venous disorders, varicose veins, chronic deep vein thrombosis, and other venous conditions.
When to Consider Referral
Venous compression syndromes and pelvic venous disorders are underdiagnosed and often fall between specialties. Consider referral for assessment in patients with any of the following:
Iliac vein compression / May-Thurner syndrome
- Unilateral (usually left) leg swelling, heaviness, or aching, out of proportion to the other side
- Unprovoked or recurrent left lower-limb DVT, particularly in younger patients
- Chronic venous symptoms not explained by, or persisting despite treatment of, superficial reflux
- Post-thrombotic symptoms with suspected proximal obstruction
Pelvic venous disorders (pelvic congestion / pelvic venous insufficiency)
- Chronic pelvic pain — classically a dull ache or heaviness that worsens through the day, with prolonged standing, or premenstrually
- Vulvar, gluteal, or atypical lower-limb varices
- Chronic pelvic pain where gynaecologic causes have been considered or excluded
Nutcracker syndrome (left renal vein compression)
- Flank pain and/or haematuria, including loin-pain haematuria presentations
- Orthostatic proteinuria, particularly in younger patients
POTS / orthostatic intolerance with venous features
- Orthostatic intolerance accompanied by pelvic pain, unilateral leg swelling, or a hypermobility/EDS diagnosis. This subgroup is increasingly recognized as having a potentially treatable venous contribution to symptom burden. Referral is for assessment not a presumption that intervention is warranted. (This reflects an area of active research, including a systematic review I co-authored.)
Referral may not be indicated for an incidental finding of mild iliac vein compression in an asymptomatic patient, or for orthostatic intolerance without any pelvic, venous, or hypermobility features. When in doubt, a referral for assessment is reasonable, and I’m happy to discuss borderline cases beforehand.
To help triage efficiently, please include with your referral: the clinical question and relevant history (symptom pattern, laterality, prior VTE), any prior imaging reports and images (duplex, CT/MR venography), prior venous interventions, current anticoagulation, and any relevant hypermobility/EDS or documented POTS workup. If no cross-sectional imaging has been done, that’s fine — imaging can be arranged as part of the workup.
How to Refer a Patient
To ensure we have all the necessary information for timely care, all referrals must be submitted by a physician or healthcare provider. Consultations and procedures, including venography, embolization and iliac vein stenting, are covered by OHIP with a physician referral. To help us triage efficiently, please include the clinical question, relevant imaging reports (CT/MR venography or ultrasound if available), and any prior venous intervention history. Unfortunately, we are unable to accept self-referrals from patients.
Referral Process:
- Download and complete current Interventional Radiology requisition form from Toronto Radiology.
- Attach any relevant patient records, including imaging reports and test results.
- Fax or email the completed referral form to:
- Fax: 416-864-5037
- Email: IRbookings@unityhealth.to
- Once received, our team will review the referral and contact the referring office to confirm next steps and schedule the patient’s appointment.
What to Expect After Submission
Once the referral is reviewed, our clinic will notify the referring physician and patient about the appointment details. If additional information is needed, we will follow up with the referring office directly to avoid any delays. Patients are typically contacted within 7 business days of a complete referral being received.