VASNHS surgeon performs Nevada’s first ovarian vein transposition

For Air Force Veteran Angelique DePalma, nearly seven years of chronic, debilitating pain went without a clear answer. Pelvic heaviness, abdominal and chest pain, unexplained weight loss, and recurring vascular issues steadily worsened despite repeated medical visits and partial diagnoses. It wasn’t until she came to VA Southern Nevada Healthcare System (VASNHS) that her symptoms were finally connected and resolved.

DePalma served as a U.S. Air Force Security Forces specialist at Nellis Air Force Base, Nevada, from 1990-94. After her military service, she transitioned to civilian law enforcement before medically retiring due to injuries. As a Las Vegas native, she turned to VASNHS after years of seeking answers in the civilian healthcare system.

“I kept getting treated for pieces of the problem, but no one was looking at the whole picture,” DePalma said. 

That changed when she was referred to VASNHS Vascular Surgeon Dr. David Finlay.

“From talking to her, based on experience, I strongly suspected Nutcracker Syndrome,” Dr. Finlay said. “But the confirmation came from imaging she hadn’t previously received.”

A CT scan revealed classic vascular compression consistent with Nutcracker Syndrome, a rare condition in which veins are compressed, disrupting blood flow and causing widespread symptoms. An ultrasound further showed extensive pelvic venous varicosities, which is a key indicator that helped to confirm the diagnosis.

“You have to ask the right questions to find this condition,” Dr. Finlay explained. “If you don’t ask, you miss it and patients often get misdiagnosed.” In his career, Dr. Finlay said he has surgically treated only about five patients with Nutcracker Syndrome. Many others with the condition are mistakenly given psychological or unrelated diagnoses when the root cause isn’t immediately obvious.

“These symptoms were real,” he said. “No one had just gone deep enough to find the source.”

Once diagnosed, Dr. Finlay recommended a left ovarian vein transposition, or an advanced vascular surgery that reroutes blood flow to relieve compression. While he typically performs a much larger version of the operation, Dr. Finlay said DePalma’s anatomy allowed for a less invasive approach. “Because of the size and location of her ovarian vein, we were able to do a smaller operation with a much smaller incision,” he said. “She went home the very next day.”

The surgery marked a major milestone as the first left ovarian vein transposition ever performed in Nevada.

Dr. Finlay explained that many providers attempt to treat Nutcracker Syndrome using stents or vein embolization, but those approaches can carry serious long-term risks.

“A stent can migrate into the heart and require emergency surgery, or eventually get crushed,” he said. “Once that happens, you can’t fix it. Open surgery isn’t easy, and many surgeons don’t do it anymore, so they go with what’s convenient, not what’s best.”

“When I woke up, the chest pain was gone,” DePalma said. “The pelvic pain and heaviness were gone. The only pain I had was from the incision, and I could immediately tell the difference.”

Prior to surgery, her pain had become so severe she struggled to eat and dropped to an unhealthy weight. “I was miserable all the time,” she said. “And that affects your whole family. Now, all of that is gone.”

After discharge, DePalma said she stopped taking prescription pain medication within days and resumed light physical activity within weeks.

Beyond the surgical success, DePalma praised the VASNHS care team for their compassion and professionalism. “It was honestly one of the best hospital experiences I’ve ever had,” she said. “Everyone was calm, confident, and kind. That made all the difference.”

For Dr. Finlay, the outcome reflects exactly why he continues to practice medicine and why he chose to work at the VA, “He joined VASNHS in 2024 after working at Mount Sinai Health System in New York. As a former Army physician, Dr. Finlay served on multiple deployments, including on humanitarian operations in Haiti. He also served at the Pentagon and White House as a travel physician for former President Bill Clinton. “Serving Veterans means a great deal to me,” he said. “Coming to the VA is about contributing and giving back.”

Today, DePalma is focused on living fully again and encouraging other Veterans to keep advocating for their health.

“Don’t give up. Don’t assume this is just the life you’re going to live,” she said. “There are incredible professionals at the VA who will keep searching — not just to manage symptoms -- but to find real solutions.”

For VASNHS, this groundbreaking surgery represents more than a first for Nevada. It underscores commitment to innovation, clinical excellence, and delivering life-changing care to Veterans, no matter how rare or complex the condition.

John Archiquette, Public Affairs Specialist

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