Ep. 460 What is POTS and Orthostatic Flow Syndrome? with Dr. Steven Smith

BackTable Vascular & Interventional

Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders.

---

CHECK OUT OUR SPONSOR

RADPAD® Radiation Protection

https://www.radpad.com/

---

SYNPOSIS

Dr. Smith details his clinical career and his surprising findings that connect pelvic congestion syndrome with a range of other conditions, such as postural orthostatic tachycardia syndrome (POTS), chronic fatigue syndrome, Ehlers-Danlos syndrome, irritable bowel syndrome (IBS), vulvodynia, interstitial cystitis, and fibromyalgia. For patients with venous manifestations, he pursues treatment with stents or embolization, taking a proactive approach to targeting any abnormal vasculature that he identifies.

Additionally, the podcast delves into the physiological basis of POTS and related disorders, which mainly stems from blood pooling in the lower body, leading to sympathetic overactivation. Overall, Dr. Smith emphasizes the significance of collaborating with specialists across different disciplines to advance understanding and treatment of these complex syndromes.

---

TIMESTAMPS

00:00 - Introduction

03:11 - Symptom Constellation of Venous Orthostatic Flow Syndrome

12:08 - Pelvic Vein Treatment Algorithm

21:08 - Physiology of Orthostatic Intolerance and Sympathetic Overdrive

27:11 - Patient Selection

33:27 - Need for Research and Collaboration

36:07 - Advocacy for Patients

---

RESOURCES

BackTable VI Ep. 337- Management of Vulvar Varices with Dr. Brooke Spencer

https://www.backtable.com/shows/vi/podcasts/337/management-of-vulvar-varices

BackTable VI Ep. 33- Building a Comprehensive Vein Practice with Dr. Brooke Spencer & Dr. Isabel Newton

https://www.backtable.com/shows/vi/podcasts/33/building-a-comprehensive-vein-practice

An online survey of pelvic congestion support group members regarding comorbid symptoms and syndromes (Smith et al, 2022):

https://journals.sagepub.com/doi/abs/10.1177/02683555221112567

Distension of central great vein decreases sympathetic outflow in humans (Cui et al, 2013):

https://journals.physiology.org/doi/full/10.1152/ajpheart.00019.2013

Orthostatic intolerance and chronic fatigue syndrome: New light on an old problem (Rowe, 2002):

https://www.jpeds.com/article/S0022-3476(02)53209-1/fulltext