133 - Symptom Profiles and Indications for Stenting in Patients with POTS and Pelvic Venous Disease

This study evaluated the symptom profiles of patients with Postural Orthostatic Tachycardia Syndrome (POTS) and Pelvic Venous Disease (PVD) who underwent stenting compared to those who did not and explored clinical indications for stenting beyond left common iliac vein (LCIV) stenosis.

Materials and Methods:

A retrospective study was conducted at Emory University from January 2023 to August 2024. Forty-eight patients diagnosed with POTS and PVD were included. All underwent pelvic venography and intravascular ultrasound (IVUS) to assess venous disease. Data on demographics, symptoms, and radiologic findings, including LCIV stenosis, venous reflux, and collateral circulation, were collected. The decision to perform stent placement was based on clinical features, including LCIV stenosis (especially if it was >50%), symptom severity, and venous pathology. Indications were analyzed, particularly when LCIV stenosis was not the main factor.

Results:

Of the 48 patients, 50% (n=24) received stents. LCIV stenosis was considered in all cases, but other factors—like venous reflux and collateral circulation—were considered in some cases. Among stented patients, the most common symptoms included pelvic/lower extremity (LE) pain (54.2%, n=13), sexual/reproductive dysfunction (12.5%, n=3), and LE swelling (12.5%, n=3). In non-stented patients, pelvic/LE pain was more prevalent (83.3%, n=20), with LE swelling (41.7%, n=10) and lightheadedness/dizziness (41.7%, n=10) also common. LCIV stenosis played a central role in decisions, but reflux and collateral circulation influenced stenting in patients with lower degrees of stenosis, particularly those presenting with pelvic pain or sexual dysfunction.

Conclusion:

This study underscores the importance of symptomatology in stent placement for POTS patients with PVD. While LCIV stenosis was key, other factors, including venous reflux and collateral circulation, were also considered when pelvic pain, sexual dysfunction, and LE swelling were present. These findings suggest a broader assessment of symptoms and venous pathology is needed when deciding on stenting interventions. Further research should refine stenting criteria in this population.