Abstract No. 87 Prevalence of Pelvic Venous Disease in the POTS Population: A Single-Institution Study

Postural orthostatic tachycardiac syndrome (POTS) is a disorder of autonomic dysregulation that can cause cardiac and neurologic symptoms that can impair quality of life. Recently, an association of this syndrome with left common iliac venous compression (LCIVC), May-Thurner Syndrome (MTS), has been postulated. The goal of this study is to report our early experience on the prevalence of pelvic venous disease in the POTS patient population, as documented on conventional pelvic venography (CPV) and intravascular ultrasound (IVUS). A retrospective review was performed on all patients 18 years of age or older with a past medical history of POTS who underwent a CPV and IVUS from January to September 2023 at a single tertiary care center. Collected and analyzed data included: patient demographics; history of POTS; lower extremity symptoms of MTS; and findings on CPV and IVUS. The search terms, interventional radiology pelvic venogram, POTS, and left common iliac vein, were used to query our institution's imaging database. Among the 18 patients in the studied period with POTS who underwent CPV and IVUS, the majority were women (n=17; 94%). All presented with at least one lower extremity (LE) symptom of MTS. The most common were pelvic or LE pain (12; 67%); LE swelling (7; 39%). Some patients also experienced gastrointestinal or genitourinary symptoms (5; 28%). On CPV review, a total of 14 patients (78%) had evidence of flow limiting left common iliac venous stenosis, of which all but 1 had stenosis greater than 50% of the luminal diameter on IVUS. Among the remaining 4 patients, none had radiographic evidence of venous flow limitation or apparent significant venous compression. There is a great female (94%) predominance of POTS patients presenting with LE symptoms. Our study suggests that a majority (78%) of POTS patients who present with LE symptoms of MTS have venographic and sonographic evidence of significant LCIVC This knowledge can enhance the treatment of LE symptoms in the management of POTS affected patients.