Mij
Senior Member (Voting Rights)
Abstract
Background: Iliac vein compression has historically been treated with iliac venous stenting for deep venous thrombosis (DVT) or unilateral left leg swelling. Recently, a relationship has been described between postural orthostatic tachycardia syndrome (POTS)/orthostatic intolerance (OI) and pelvic venous disorders (PeVD). The authors hypothesize that venous outflow obstruction from iliac vein compression exacerbates POTS/OI symptomatology.
Methods: The primary objective of this study was to explore quality-of-life (QoL) outcomes in female patients with POTS/OI after treatment of PeVD with iliac vein stenting. The secondary objective was to record the incidence of associated pelvic pain and response to therapy in this population. A retrospective review of medical records was conducted for 271 female patients from June 2019 to January 2025 to collect standard pre- and post-procedure QoL assessment scores.
Findings: Significant improvements were seen in Orthostatic Hypotension Questionnaire (OHQ) composite scores following stenting, with the mean decreasing from 6·23 to 3·58 at three months post-procedure (p<0·001) and to 3·67 at 12 months post-procedure (p<0·001). The OHQ Symptom Assessment (OHSA) and Daily Activities Scale (OHDAS) subscores similarly improved at both three months and 12 months post-procedure (all p<0·001). The International Pelvic Pain Society (IPPS) score, Pelvic Congestion Syndrome (PCS) score, Pelvic Pain and Urgency/Frequency Symptom Scale (PUF) score, and Ancillary symptom score all demonstrated statistically significant decrease at three months that persisted at 12 months.
Interpretation: Significant improvements were seen in QoL in patients with POTS/OI and PeVD who underwent iliac vein stenting. The results from this study call for blinded randomized sham-controlled trials and objective measures trials to examine the clinical and hemodynamic effects of venous stenting on POTS/OI symptomatology and associated systemic symptoms, including pelvic pain.
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Background: Iliac vein compression has historically been treated with iliac venous stenting for deep venous thrombosis (DVT) or unilateral left leg swelling. Recently, a relationship has been described between postural orthostatic tachycardia syndrome (POTS)/orthostatic intolerance (OI) and pelvic venous disorders (PeVD). The authors hypothesize that venous outflow obstruction from iliac vein compression exacerbates POTS/OI symptomatology.
Methods: The primary objective of this study was to explore quality-of-life (QoL) outcomes in female patients with POTS/OI after treatment of PeVD with iliac vein stenting. The secondary objective was to record the incidence of associated pelvic pain and response to therapy in this population. A retrospective review of medical records was conducted for 271 female patients from June 2019 to January 2025 to collect standard pre- and post-procedure QoL assessment scores.
Findings: Significant improvements were seen in Orthostatic Hypotension Questionnaire (OHQ) composite scores following stenting, with the mean decreasing from 6·23 to 3·58 at three months post-procedure (p<0·001) and to 3·67 at 12 months post-procedure (p<0·001). The OHQ Symptom Assessment (OHSA) and Daily Activities Scale (OHDAS) subscores similarly improved at both three months and 12 months post-procedure (all p<0·001). The International Pelvic Pain Society (IPPS) score, Pelvic Congestion Syndrome (PCS) score, Pelvic Pain and Urgency/Frequency Symptom Scale (PUF) score, and Ancillary symptom score all demonstrated statistically significant decrease at three months that persisted at 12 months.
Interpretation: Significant improvements were seen in QoL in patients with POTS/OI and PeVD who underwent iliac vein stenting. The results from this study call for blinded randomized sham-controlled trials and objective measures trials to examine the clinical and hemodynamic effects of venous stenting on POTS/OI symptomatology and associated systemic symptoms, including pelvic pain.
LINK