81 - Clinical Symptoms Improvement After Iliac Vein Stenting in POTS and Pelvic Venous Disease: A Single Center Experience

Purpose: Postural Orthostatic Tachycardia Syndrome (POTS) with concurrent Pelvic Venous Disease (PVD) is poorly understood, and data on symptom trajectories following Left Common Iliac Vein (LCIV) stenting is limited. This study evaluates post-stenting symptom course in this unique patient population.

Materials and Methods: A retrospective study was conducted at a large single-center academic institution between 06/2023-06/2025. Twenty-nine patients with POTS and PVD who underwent LCIV stenting were included. All patients had pelvic venography, intravascular ultrasound (IVUS), and LCIV stenting. Indications for stenting included IVUS narrowing >50% and presence of lumbar or pelvic collaterals. Demographics, pre-/post stenting symptoms, and follow-up interventions up to one year were collected. Symptoms assessed include pelvic pain (pressure/heaviness), cardiac (palpitations/tachycardia), neurologic (headache/brain fog), fatigue (exertional/orthostatic), genitourinary (frequency/urgency), reproductive (dyspareunia/dysfunction), gastrointestinal (nausea/abdominal discomfort), lower extremity swelling (edema), and lightheadedness.

Results: Of the 29 patients, 28 had 8-week follow-up data and 15 patients had 1 year follow-up. At 8 weeks, patients reporting improvement or complete resolution included pelvic pain (n=23/26), neurological (n=12/14), fatigue (n=9/9), gastrointestinal (7/10), lower extremity swelling (13/19), and lightheadedness (n=13/14). At 1 year, improvements were seen in pelvic pain (n=10/14), neurological (n=5/6), lower extremity swelling (n=6/9), and lightheadedness (n=4/7). Worsening symptoms at 8 weeks included pelvic pain (n=1/26), genitourinary (n=1/4), and lower extremity swelling (n=1/19). At 1 year, worsening symptoms included pelvic pain (n=2/14), lower extremity swelling (n=1/9), and lightheadedness (n=1/7). Only two patients underwent subsequent procedures within one year including saphenous vein ablation to help treat persistent venous pooling.

Conclusion: LCIV stenting in patients with POTS and PVD was associated with improvement in multiple symptoms. At 8 weeks, 61% (n=17/28) of patients had a complete recovery or improvement of all symptoms. However, there are cases where patients reported persistent or worsening symptoms, highlighting the need for careful follow-up and adjunctive therapies in select cases.