Ep. 460 What is POTS and Orthostatic Flow Syndrome? with Dr. Steven Smith
06/28/24 • 45 min
Dr. Ally Baheti interviews interventional radiologist Dr. Steven Smith about his insights into venous orthostatic flow dysfunction and its association with multisystem disorders.
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RADPAD® Radiation Protection
https://www.radpad.com/
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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.
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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
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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
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
Previous Episode
Ep. 459 Transitioning from Academia to Private OBL Practice with Dr. Jafar Golzarian
Dr. Jafar Golzarian shares his experiences with co-founding an outpatient-based lab (OBL), obtaining the right equipment, handling staffing, negotiating with insurance companies, and marketing his new practice. Dr. Golzarian is an interventional radiologist at his OBL in Minneapolis, Minnesota and he is the former Division Head and Program Director for the interventional radiology program at the University of Minnesota.
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CHECK OUT OUR SPONSOR
GE Healthcare Allia Image Guided Systems
https://www.gehealthcare.com/products/interventional-image-guided-systems/allia
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SYNPOSIS
Dr. Golzarian emphasizes the importance of having independence and adopting a patient-centered approach. He also offers practical advice for physicians considering similar moves into the private practice sphere. Additionally, Dr. Golzarian talks about the challenges and rewards of focusing on specific embolization procedures and collaborating with industry partners to build a successful practice.
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TIMESTAMPS
00:00 - Introduction
06:06 - Setting Up a New Practice
14:27 - Tips for Marketing
23:40 - Finding the Right Business Partner
30:44 - OBL vs. ASC Status and Reimbursement
32:59 - Industry Support and Device Costs
37:58 - Staffing and Culture
45:25 - Advice for New Practitioners
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RESOURCES
BackTable VI Episode #85 - Genicular Artery Embolization for OA with Dr. Jafar Golzarian:
https://www.backtable.com/shows/vi/podcasts/85/genicular-artery-embolization-for-oa
BackTable VI Episode #361 - Intra-Arterial & Percutaneous Treatment of Giant Hepatic Hemangiomas with Dr. Jafar Golzarian:
https://www.backtable.com/shows/vi/podcasts/361/intra-arterial-percutaneous-treatment-of-giant-hepatic-hemangiomas
BackTable VI Episode #447 - Exploring GAE: Clinical Insights & Outcomes with Dr. Mark Little:
https://www.backtable.com/shows/vi/podcasts/447/exploring-gae-clinical-insights-outcomes
GEST MSK Annual Meeting:
https://www.gestmsk.com/
Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline:
https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline
Next Episode
Ep. 461 Advanced Radial to Peripheral Interventions with Dr. Sameh Sayfo
Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program.
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CHECK OUT OUR SPONSOR
AngioDynamics Auryon System
https://www.auryon-system.com/
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SYNPOSIS
Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other’s experiences to improve patient outcomes.
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TIMESTAMPS
00:00 - Introduction
05:24 - Incorporating Radial into Peripheral Practice
11:19 - Right vs. Left Radial Access
20:01 - Room Setup and Procedure Planning
25:13 - Radial vs. Femoral Access
33:01 - Advancements in Laser Atherectomy
41:33 - Laser Atherectomy Tips
45:52 - Advantages of Radial Access in Specific Cases
51:33 - Post-Op Care and Best Practices
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RESOURCES
BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman:
https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced
BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons:
https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization
BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros:
https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad
BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo:
https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique
BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava:
https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions
BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das:
https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry
BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas:
https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions
Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience:
https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract
Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry:
https://pubmed.ncbi.nlm.nih.gov/37318023/
Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK:
https://pubmed.ncbi.nlm.nih.gov/38458581/
Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions:
https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext
Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry:
https://pubmed.ncbi.nlm.nih.gov/38566525/
SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention:
https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial
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