The co-author names were omitted from the following abstract (written below in full) which appears on page 19 of the abstract supplement published in Phlebology (DOI: 10.1177/0268355519893876; Volume 34 Issue 2_suppl, December 2019) on behalf of the American Vein and Lymphatic Society (AVLS), 33rd Annual Congress (7–10 November 2019).
Potential relationship between venous insufficiency and orthostatic hypotension
Arman Raz, Razieh Mohseni, Courtney Pustay, Tina Amos and Shelly Loze
Vein Clinics of Lake county LLC
Introduction, objectives, and/or purpose:
Background: Symptoms of orthostatic hypotension have been well documented for decades, but identifying the cause is often elusive. While many cases are attributed to an autonomic dysfunction, drug side effects, and systemic diseases, there remain a significant number of cases where a clear etiology is not found.
Aim: To evaluate postoperative impacts of ablative treatment of venous insufficiency on sit to stand decrease of systemic blood pressure (systolic or diastolic) and on increase in sit to stand heart rate, and to determine its potential role in orthostatic hypotension.
Methods: We measured the degree of decrease in systolic BP, diastolic BP, as well as increase in heart rate associated with change of position from sit to stand. They were flagged as positive if the values from sitting to standing showed at least a 20 mmHg systolic drop, 10 mmHg diastolic drop, or 10 bpm heart rate increase.
Results: Treatment of venous insufficiency involved ablation of truncal varicosities using laser or radiofrequency ablation procedures and chemical ablation using foam sclerotherapy to large residual varicosities. A total of 646 patients were selected based on the original orthostatic vital signs, with 178 flagged as positive based on selection criteria. Of the 178 positive patients, 59 showed a systolic drop of 20 mmHg or greater, 24 showed a diastolic drop of 10 mmHg or greater, and 123 showed a rise in heart rate by 10 bpm or greater. Data regression showed that after ablative vein treatments, the magnitude of drop in BP (systolic or diastolic), or increase in HR, was significantly reduced (systolic pressure (p = 0.001), diastolic pressure (p = 0.001), and heart rate spike (p = 0.001)).
Conclusion(s): Our data strongly support that ablative treatments play a potentially significant role in improving orthostatic vital signs. In this study, positive patients, postoperatively, showed statistically significant improvement of their orthostatic vital signs. Although orthostatic hypotension can result from autonomic dysfunction or other systemic conditions, those with concomitant venous insufficiency may have a more dramatic blood pressure drops due to the large lower extremity venous reservoir. In such cases, venous assessment and treatment of venous insufficiency may offer a potential venue to patients with resistant orthostatic hypotension.
