Medical Disclaimer: The information provided in this article is for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment. Individual conditions and treatment options vary. Always consult your healthcare provider regarding your specific medical concerns.
Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that can be confusing and frustrating for patients. Symptoms are very real and can significantly affect daily life, yet the exact cause isn’t always clear. This has led to questions about whether vein problems — especially iliac vein compression (May-Thurner syndrome) — may play a role.
This article explains what POTS is, the different types of POTS, what we know and don’t know, and why caution is critical before considering vein stents.
What Is POTS?
POTS stands for Postural Orthostatic Tachycardia Syndrome.
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Postural: related to the position of your body
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Orthostatic: related to standing upright
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Tachycardia: an increased heart rate
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Syndrome: a group of symptoms
POTS is a form of dysautonomia, meaning the autonomic (automatic) nervous system does not regulate heart rate and blood flow normally.
POTS is defined by a significant increase in heart rate when moving from lying down to standing, usually without the large drop in blood pressure seen in classic orthostatic hypotension.
That said, this definition is not absolute. Some patients with POTS can experience low blood pressure, especially after standing for a longer period of time. Others may even experience increases in blood pressure when standing. POTS does not look exactly the same in every person.
Common symptoms include dizziness or lightheadedness, rapid heartbeat or palpitations, fatigue, brain fog, shortness of breath, and difficulty tolerating standing or exercise.
The Different Types of POTS
POTS is best thought of as a syndrome, not a single disease. There are several commonly described types, and many patients have features of more than one.
Neuropathic POTS involves dysfunction of small nerves that normally help blood vessels tighten when standing. When these nerves don’t work properly, blood can pool in the legs and abdomen, causing symptoms.
Hyperadrenergic POTS is related to an overactive stress response when standing. Patients may notice strong palpitations, tremors, anxiety-like feelings, and sometimes higher blood pressure when upright.
Hypovolemic POTS is associated with lower overall blood volume. With less circulating blood, the heart rate rises to compensate when standing.
Secondary POTS occurs when POTS develops in association with another medical condition, such as autoimmune disease or chronic illness like Long COVID syndrome.
These categories are not rigid, and ongoing research continues to refine how POTS is classified.
What We Still Don’t Know
Despite growing awareness, there is still much we do not fully understand about POTS. Symptoms can vary widely from person to person, and there is no single test that definitively explains the condition.
Because of this, many patients unfortunately feel dismissed or misunderstood. Some are told their symptoms are “just anxiety,” that nothing is wrong, or that they should see a psychiatrist. This can be incredibly frustrating and isolating for people who know their symptoms are real.
This uncertainty makes careful listening, validation, and a thoughtful medical evaluation especially important.
May-Thurner Syndrome and POTS: Association Is Not the Same as Cause
May-Thurner syndrome (MTS) refers to compression of the left iliac vein by the right iliac artery. Importantly, iliac vein compression is actually common, even in people without symptoms.
MTS can be seen in some patients with POTS, but it is not considered a cause of POTS. Finding vein compression on imaging does not automatically mean it explains a patient’s symptoms.
Why Iliac Vein Stenting Requires Extreme Caution
Iliac vein stenting is sometimes discussed when POTS and iliac vein compression are found together. This is where careful decision-making is essential.
A stent can be placed quickly, but the patient lives with that stent for a lifetime. Stents carry risks, including clotting, migration, and the need for long-term follow-up. While POTS symptoms may improve after stenting in select cases, they may also not improve at all.
If a patient’s only symptoms are related to POTS, and there are no other signs of May-Thurner syndrome—such as leg swelling, leg pain, or pelvic congestion—stenting should be approached with extreme caution, or not pursued at all.
The Importance of an Experienced Vascular Specialist
An experienced vascular specialist will thoroughly evaluate your past medical history and how your current symptoms align with POTS and/or May Thurner syndrome before recommending a stent. Vein compression seen on imaging alone should never be the sole reason for placing a lifelong stent in the body. He/she will also evaluate you for other conditions that can mimic your vascular symptoms such as chronic venous insufficiency which is statistically much more common than May Thurner syndrome.
Vein compression seen on imaging alone should never be the sole reason for placing a lifelong stent in the body.
Care works best when there is collaboration between the vascular specialist and your primary care provider, and when needed, other specialists such as neurologists or cardiologists. Symptoms, imaging findings, and overall health must be considered together.
Bottom Line
POTS is a complex condition with different types and contributing factors, and it does not look the same in every patient. While POTS is often defined as occurring without significant drops in blood pressure, low or high blood pressure can still be seen in some patients.
May-Thurner syndrome may coexist with POTS, but it is not a proven cause. In patients with POTS and no clear evidence of May-Thurner syndrome, extreme caution is warranted when considering iliac vein stenting—or no stent at all may be the most appropriate choice.
Placing a stent takes minutes. Living with it lasts a lifetime. Careful evaluation and thoughtful decision-making are essential to doing what is truly best for the patient.
