POTS and Compressive Venous Syndromes

Learning Objectives: -Define the diagnostic criteria and clinical manifestations of Postural Orthostatic Tachycardia Syndrome (POTS), and the clinical spectrum of pelvic venous disease (PeVD)

-Recognize the emerging clinical associations and pathophysiologic overlap between POTS and PeVD, and current gaps in the literature

-Review illustrative case examples of PeVD in POTS patients, including relevant technical considerations

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is characterized by chronic orthostatic intolerance with either a relative > 30 beat/minute increase in heart rate upon standing, or an absolute heart rate > 120 bpm, within 10 minutes of standing {1}. POTS is more common in young women and presents with non-specific symptoms related to sympathetic activation. Pelvic venous disease (PeVD) is a spectrum of conditions historically known as May Thurner, Pelvic Congestion Syndrome, and Nutcracker syndrome, characterized by venous compression and reflux. There is a growing body of literature which suggests a clinical overlap between PeVD and POTS.

Clinical Findings/Procedure Details: This educational exhibit will present illustrative case examples of POTS patients treated for PeVD. A brief discussion of pertinent technical points will be included, along with clinical follow up as available.

We will also provide a comprehensive literature review of recent studies highlighting the overlap between PeVD and POTS, with a few key recent studies highlighted in table 1.

Conclusion and/or Teaching Points: There is a growing body of evidence which suggests an association between POTS and pelvic venous disease. Retrospective data shows improved orthostatic intolerance following endovascular treatment for PeVD in POTS patients, necessitating future randomized control trials in this patient population.