Abstract 15621: Pelvic Vein Compression in Patients Diagnosed With Postural Orthostatic Tachycardia Syndrome

Abstract

Introduction: Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by chronic orthostatic intolerance and a significant increase in heart rate. Patients with POTS often exhibit symptoms suggestive of pelvic venous congestion. While venography is the standard method for diagnosing venous compression disorders in the abdomen and pelvis, its potential use in identifying undiagnosed venous abnormalities and its relationship in POTS patients has not been studied. Research Question: This study aimed to investigate the findings of antegrade venography and intravascular ultrasound in patients diagnosed with POTS with high suspicion of May-Thurner Syndrome (MTS) and/or pelvic congestion syndrome, based on initial diagnostic tools such as ultrasound, and who exhibited symptoms of pelvic venous insufficiency (PVI). Methods: Patients clinically diagnosed with POTS underwent antegrade venography and intravascular ultrasound due to a high suspicion of PVI. Demographic, clinical presentation, and venography findings were extracted from the electronic medical records of patients referred to Emory University for POTS/dysautonomia/long COVID evaluation. Patients were diagnosed with MTS if they demonstrated stenosis of the left common iliac vein of 50-70% with associated symptoms like pelvic pain and lower extremity swelling. Results: We identified 28 patients with POTS who had symptoms of PVI. The mean age was 31.6 years (range 18-54), and 96% were female. Doppler ultrasonography revealed venous reflux in the common femoral vein in 82% of the patients. All participants met the criteria for MTS and were referred for stenting. Additionally, 21% of those evaluated had significant bilateral iliac vein compression. Conclusions: This is the largest cohort of POTS patients with pelvic venous compression to date, and our findings suggest a potential association between venous disease and the pathophysiology of POTS. Further research is needed to establish a causal link and explore the clinical implications of venography findings after intervention with angioplasty and stenting. Understanding the venous component in POTS may aid clinicians in the earlier diagnosis and management of PVI.