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Fahrni JO, Cho EYN, Engelberger RP, Baumgartner I, von Känel R. Quality of life in patients with congenital vascular malformations. J Vasc Surg Venous Lymphat Disord 2013; 2:46-51. [PMID: 26992968 DOI: 10.1016/j.jvsv.2013.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess quality of life (QoL) in patients with congenital vascular malformations (CVMs) and to identify factors of CVMs associated with poor QoL, including high psychological and/or somatic (physical) distress. METHODS We evaluated 71 patients (mean age, 40 ± 16 years; 51% women) with arteriovenous (n = 10), venous/capillary (n = 34), lymphatic (n = 10), and combined (n = 17) malformations. All patients completed validated psychometric assessment tools, which were the 36-Item Short Form Health Survey, the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire-15, and the Pain Disability Index. RESULTS Compared with population norms, the group of CVM patients as a whole showed lower 36-Item Short Form Health Survey Physical (46 vs 50) and Mental (46 vs 52) Component Summary scores, indicating impaired physical and mental health. In addition, 13% of patients with CVMs had clinically relevant psychological distress (Hospital Anxiety and Depression Scale total scores ≥17), and 15% had increased somatic distress (Patient Health Questionnaire-15 total scores ≥10). Greater levels of psychological and somatic distress were significantly associated with lower scores of virtually all of the eight 36-Item Short Form Health Survey subscales (P < .05). CONCLUSIONS Our findings suggest that, compared with a normal population, CVM patients have a lower QoL that is accompanied by increased psychological and somatic distress. In treating patients with CVMs, it is important to be aware of the psychological impact of this rare illness and to offer appropriate support.
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Affiliation(s)
- Jennifer O Fahrni
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - En-Young N Cho
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Rolf P Engelberger
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Iris Baumgartner
- Swiss Cardiovascular Center, Division of Angiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Roland von Känel
- Department of General Internal Medicine, Division of Psychosomatic Medicine, Bern University Hospital, Inselspital, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland.
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52
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Puiu I, Stoica A, Sosoi S, Puiu A, Ioana M, Burada F. Terminal deletion 2q37.3 in a patient with Klippel-Trenaunay-Weber syndrome. Fetal Pediatr Pathol 2013; 32:351-6. [PMID: 23438794 DOI: 10.3109/15513815.2013.768739] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital disorder, characterized by capillary, venous and lymphatic vascular malformations in association with bone and soft tissue hypertrophy. We report a KTWS patient with extensive hemangiomatosis of the right lower limb, trunk and upper limbs; bone and soft tissue hypertrophy of upper limbs, scapular girdle and right lower limb; and muscle atrophy on left lower limb with marked body asymmetry, scoliosis and toe malformations. These pathological features are associated with moderate mental retardation, mild renal and hepatic abnormalities. We identified by array CGH (Comparative Genomic Hybridization) a submicroscopic deletion 2q37.3 that could be related to impaired cognitive function. To our knowledge this is the first reported 2q37.3 microdeletion in a patient with KTWS.
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Affiliation(s)
- Ileana Puiu
- Department of Pediatrics, University of Medicine and Pharmacy from Craiova, Romania
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53
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Lee BB. Venous malformation and haemangioma: differential diagnosis, diagnosis, natural history and consequences. Phlebology 2013; 28 Suppl 1:176-87. [DOI: 10.1177/0268355513475960] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Venous malformation (VM) is the most common form of congenital vascular malformation (CVM). VM presents at birth as an inborn vascular defect and never disappears/regresses spontaneously through the rest of life; it will continue to grow slowly at a rate that is proportional to the growth rate of the body. Haemangioma is not a vascular malformation but one of the vascular tumours originating from the endothelial cells; it develops after birth mostly in the infantile/neonatal period with a distinctive growth cycle: a proliferation phase of early rapid growth followed by an involutional phase of slow regression. Although the vascular malformation and vascular tumour belong to the ‘vascular anomaly’ together, both conditions are fundamentally different not only in their anatomical, histological and pathophysiological findings but also in their clinical courses. Therefore, an appropriate differential diagnosis of the VM is mandated not only from other kinds of CVMs but also from ‘genuine’ haemangioma. Appropriate diagnosis and assessment of VMs can be made based on clinical presentation and a proper combination of basic non-invasive studies in general but the presence of a mixed lesion involving other types of CVM lesions and the type of VM lesion, extratruncular and truncular, will dictate the need for further work-up with additional non- to less-invasive study or angiography. Otherwise, angiography is usually reserved for therapeutic planning and treatment.
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Affiliation(s)
- B B Lee
- Center for the Lymphedema and Vascular Malformations, George Washington University, Washington, DC, USA
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54
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Elevated Soft Tissue Activity in Early but not Delayed Phase of Bone Scan in Klippel-Trenaunay Syndrome. Clin Nucl Med 2013; 38:223-5. [DOI: 10.1097/rlu.0b013e3182814cab] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Laroche JP, Becker F, Khau-Van-Kien A, Baudoin P, Brisot D, Buffler A, Coupé M, Jurus C, Mestre S, Miserey G, Soulier-Sotto V, Tissot A, Viard A, Vignes S, Quéré I. [Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the French Society for Vascular Medicine]. JOURNAL DES MALADIES VASCULAIRES 2013; 38:29-42. [PMID: 23312609 DOI: 10.1016/j.jmv.2012.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/08/2012] [Indexed: 01/19/2023]
Abstract
THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.
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Affiliation(s)
- J-P Laroche
- Médecine interne B, médecine vasculaire, hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Scribner DR, Lara-Torre E, Heineck RJ, Weiss PM. Klippel-Trenaunay syndrome complicated by ascites and vaginal lymphatic drainage in adolescence: a case report. J Pediatr Adolesc Gynecol 2012; 25:e139-41. [PMID: 23062447 DOI: 10.1016/j.jpag.2012.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/09/2012] [Accepted: 07/11/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Klippel-Trenaunay syndrome is a rare disease characterized by capillary malformationsand soft tissue and bony hypertrophy and atypical varicosities. Management of this syndrome is focused primarily on treatment of the complications that arise from these malformations. Ascites and lymphedema are two of the more common complications in these patients. CASE A 15-year-old female with Klippel-Trenaunay syndrome presented with chylous ascites, vaginal drainage, and unilateral lower extremity lymphedema. Treatment included dilation, hysteroscopy and curettage, and laparoscopic evacuation of abdomino-pelvic ascites with resolution of symptoms for 32 months. Repeat laparoscopic drainage was successful and remains symptom free after 12 months. CONCLUSION Vaginal drainage of chylous ascites is a rare complication from Klippel-Trenaunay syndrome and can be successfully managed by techniques to remove abdomino-pelvic ascites.
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57
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Atis A, Ozdemir G, Tuncer G, Cetincelik U, Goker N, Ozsoy S. Management of a Klippel-Trenaunay syndrome in pregnant women with mega-cisterna magna and splenic and vulvar varices at birth: A case report. J Obstet Gynaecol Res 2012; 38:1331-4. [DOI: 10.1111/j.1447-0756.2012.01867.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Overgrowth syndromes, although rare, are diagnosed more frequently lately. Major progress, such as the identification of genetic causes, has recently enhanced the delineation of the characteristic and noncharacteristic manifestations, phenotype-genotype correlations and knowledge of the underlying pathophysiologic mechanisms. This review provides a summary of the most important overgrowth syndromes aiming to familiarize the treating physician with the cardinal clinical features involved in these syndromes that encompass overgrowth, but also have a variety of other clinical manifestations (neurologic, musculoskeletal, skin, and accompanying tumors).
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59
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Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F, Campisi C, Boccardo F. Current views on diagnostic approach and treatment of lymphedema. Am J Med 2012; 125:134-40. [PMID: 22269614 DOI: 10.1016/j.amjmed.2011.06.032] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 10/14/2022]
Abstract
Lymphedema is a chronic, progressive, and often debilitating condition. Primary lymphedema is a lymphatic malformation developing during the later stage of lymphangiogenesis. Secondary lymphedema is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, infection, inflammation, and radiation therapy. In this review, we report an update upon the diagnostic approach and the medical and surgical therapy for both primary and secondary lymphedema.
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60
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Chow V, Wang W, Wilson M, Yiannikas J. Thrombus in transit within a patent foramen ovale: an argument for consideration of prophylactic closure? JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:115-118. [PMID: 21500200 DOI: 10.1002/jcu.20820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/12/2011] [Indexed: 05/30/2023]
Abstract
Recurrent pulmonary embolism (PE) in prothrombotic patients with patent foramen ovale (PFO) is not considered a setting for elective PFO closure. We describe a 35-year-old woman with known PFO, recurrent PE on warfarin, and Klippel-Trenaunay syndrome-a condition with predisposition for thromboembolism-who suffered concurrent saddle PE and devastating stroke with further impending paradoxical embolus across the PFO. Optimal management in patients with biatrial thromboembolus caught in transit across PFO is challenging. Patients with recurrent PE, prothrombotic states, and PFO should be considered for PFO closure. Prompt diagnosis of impending paradoxical embolus with echocardiography and consideration of surgical removal and PFO closure are critical.
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Affiliation(s)
- Vincent Chow
- Department of Cardiology, Concord Hospital, University of Sydney, Hospital Road, Concord NSW 2139, Australia
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61
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Lee JH, Chung HU, Lee MS. An anesthetic management of a patient with Klippel-Trenaunay syndrome. Korean J Anesthesiol 2012; 63:90-1. [PMID: 22870375 PMCID: PMC3408525 DOI: 10.4097/kjae.2012.63.1.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Joon-Ho Lee
- Department of Anesthesiology and Pain Medicine, Bucheon Hospital, Soonchunhyang University, Bucheon, Korea
| | - Hae-Un Chung
- Department of Anesthesiology and Pain Medicine, Bucheon Hospital, Soonchunhyang University, Bucheon, Korea
| | - Mi-Soon Lee
- Department of Anesthesiology and Pain Medicine, Bucheon Hospital, Soonchunhyang University, Bucheon, Korea
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62
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Redondo P, Aguado L, Martínez-Cuesta A. Diagnosis and management of extensive vascular malformations of the lower limb: part I. Clinical diagnosis. J Am Acad Dermatol 2011; 65:893-906; quiz 907-8. [PMID: 22000870 DOI: 10.1016/j.jaad.2010.12.047] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 12/01/2010] [Accepted: 12/03/2010] [Indexed: 01/19/2023]
Abstract
There is significant confusion in the literature when describing vascular anomalies, and vascular malformations are often misnamed or incorrectly classified. Part I of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limbs will discuss the dermatologist's role in the diagnosis of these lesions. At least nine types of vascular malformations with specific clinical and radiologic characteristics must be distinguished in the lower limbs: Klippel-Trénaunay syndrome, port-wine stain with or without hypertrophy, cutis marmorata telangiectatica congenita, macrocephaly-capillary malformation, Parkes Weber syndrome, Stewart-Bluefarb syndrome, venous malformation, glomuvenous malformation, and lymphatic malformation. This article highlights the differences in clinical appearance and discusses the differential diagnosis of extensive vascular malformations in an attempt to ensure earlier diagnosis and better outcomes for these patients.
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Affiliation(s)
- Pedro Redondo
- Unit of Vascular Malformations, Department of Dermatology, University Clinic of Navarra, Pamplona, Spain.
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63
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Maruani A, Samimi M, Lorette G. Les angiomes plans de membres. Ann Dermatol Venereol 2011; 138:700-5; quiz 699, 706. [DOI: 10.1016/j.annder.2011.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/25/2011] [Accepted: 06/07/2011] [Indexed: 01/19/2023]
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64
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The role of radiology in the planning management of Klippel Trenaunay Syndrome (KTS). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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65
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Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53:2S-48S. [PMID: 21536172 DOI: 10.1016/j.jvs.2011.01.079] [Citation(s) in RCA: 826] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 12/20/2022]
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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66
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Barbara DW, Wilson JL. Anesthesia for surgery related to Klippel-Trenaunay syndrome: a review of 136 anesthetics. Anesth Analg 2011; 113:98-102. [PMID: 21467557 DOI: 10.1213/ane.0b013e31821a03c2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trenaunay syndrome (KTS) is a rare congenital malformation characterized by the triad of varicose veins or venous malformations, capillary malformations that may involve neurovascular structures, and bony or soft tissue hypertrophy in affected limbs. Areas such as the trunk, bowel, bladder, and spinal cord may be involved as well. KTS should not be confused with Klippel-Feil syndrome, which involves abnormalities of the cervical vertebrae. Anesthetic management for patients with KTS has only been described in limited case reports that caution about potential airway difficulty but do not report surgical hemorrhage requiring transfusion. METHODS We performed an electronic search of the Mayo Clinic medical record database to identify patients who had undergone an anesthetic for surgery related to KTS. Review of medical records was performed for type of surgery, anesthetic technique, airway management and difficulty, medications used, intraoperative fluid administration, transfusion requirements, vascular access used, and postoperative complications. RESULTS Eighty-two unique patients were identified who underwent 134 general anesthetics and 2 lumbar neuraxial anesthetics for surgeries related to KTS. Preoperatively, 27% of patients had a history of recurrent bleeding, 24% recurrent cellulitis, 9% deep vein thrombosis, and 2% pulmonary embolism. The mean age at time of surgery was 21 ± 15 years. The majority of surgical procedures involved laser coagulation or varicose vein sclerotherapy or stripping. All of the 74 direct laryngoscopies and tracheal intubations were performed on the first attempt without difficulty. Mask ventilation was possible in all 131 patients for whom this was attempted, with only 1 requiring an oral airway. Documented estimated blood loss ranged from 20 to 18,000 mL, with a mean of 740 ± 2739 mL. Use of a tourniquet did not obviate the possibility of substantial blood loss. The only significant postoperative complication involved a calf hematoma after vein stripping and avulsion that required return to the operating room for evacuation. CONCLUSIONS Patients with KTS have multiple associated comorbidities relevant to perioperative management. In contrast to previous reports, difficulty with airway management was not encountered. Surgery related to severe KTS may be associated with massive hemorrhage despite tourniquet use, and the anesthesiologist should anticipate the need for appropriate fluid resuscitation. Neuraxial techniques may be considered only if the possibility of trauma to neurovascular malformations has been excluded with recent spine imaging.
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Affiliation(s)
- David W Barbara
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905, USA
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67
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Cahill AM, Nijs ELF. Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 2011; 34:691-704. [PMID: 21409475 DOI: 10.1007/s00270-011-0123-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 02/01/2011] [Indexed: 01/19/2023]
Abstract
The Mulliken and Glowacki classification (1982) differentiated vascular anomalies into two groups based on their endothelial characteristics: hemangiomas and vascular malformations. Vascular anomalies are localized defects of the vasculature that affect a limited number of vessels in a restricted area of the body. These defects are secondary to errors in vascular morphogenesis. Depending on the type of vessel involved, the vascular malformation group was subdivided into high-flow (such as arteriovenous malformation and arteriovenous fistula) and low-flow lesions (such as venous and lymphatic malformations). Depending on the type of lesion, the location and degree of involvement and the clinical effect, different types of treatment would be required. For the purpose of this review, we concentrate solely on vascular malformations: the clinical features, genetics, diagnosis, and current treatment options.
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Affiliation(s)
- Anne Marie Cahill
- Department of Interventional Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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68
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Flumignan RLG, Cacione DG, Lopes SI, Clezar CNB, Queiroz CD, Pereira-Filho ARD, Barros Jr ND, Miranda Jr F. Síndrome de Klippel-Trenaunay-Weber: associação do tratamento operatório à escleroterapia por espuma. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A Síndrome de Klippel-Trenaunay-Weber representa a associação de hemangiomas planos, ectasias venosas e hipertrofia do segmento corpóreo afetado. Apresenta-se o caso de um paciente de 39 anos, sexo masculino, seguido desde 1993 no serviço da Disciplina de Cirurgia Vascular da Escola Paulista de Medicina (Unifesp), por quadro inicial da síndrome em membro inferior esquerdo. O paciente foi tratado apenas por elastocompressão e medidas gerais. Neste período, ele evoluiu com piora da estase venosa, da hipertrofia óssea e da hiperpigmentação de pele. Na ultrassonografia Doppler colorida venosa dos membros inferiores havia perviedade do sistema venoso profundo, hiperfluxo venoso, insuficiência segmentar de veia safena magna com sinais de tromboflebite e tributárias insuficientes. Indicou-se, para a melhora da estase venosa, ligadura da junção safeno-femoral esquerda e escleroterapia (polidocanol 3%) retrógrada da mesma, com exérese das ectasias venosas. O paciente recebeu alta hospitalar no primeiro dia pós-operatório e atualmente está em acompanhamento ambulatorial com melhora significativa dos sintomas.
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71
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Martin JR, Pels SG, Paidas M, Seli E. Assisted reproduction in a patient with Klippel-Trenaunay syndrome: management of thrombophilia and consumptive coagulopathy. J Assist Reprod Genet 2010; 28:217-9. [PMID: 21188495 DOI: 10.1007/s10815-010-9526-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/14/2010] [Indexed: 12/19/2022] Open
Abstract
Klippel-Trenaunay Syndrome (KTS) is a rare, sporadic triad of congenital malformations involving an extensive port wine stain, soft tissue or bone hypertrophy and underlying venous and/or lymphatic malformation involving an extremity. Pregnancy is known to exacerbate KTS complications and can put women at increased obstetrical risk due to deep venous thrombosis and other thromboembolic events. Here we report a case of a patient with KTS who achieved a pregnancy through in vitro fertilization (IVF) using her own eggs and a gestational surrogate in the setting of hypercoagulability and chronic consumptive coagulopathy.
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Affiliation(s)
- J Ryan Martin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA
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72
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Klippel-Trenaunay-Syndrom. Monatsschr Kinderheilkd 2010. [DOI: 10.1007/s00112-010-2337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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73
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Liu NF, Lu Q, Yan ZX. Lymphatic malformation is a common component of Klippel-Trenaunay syndrome. J Vasc Surg 2010; 52:1557-63. [DOI: 10.1016/j.jvs.2010.06.166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/22/2010] [Accepted: 06/23/2010] [Indexed: 01/19/2023]
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74
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Vascular skin lesions in a child with Klippel-Trénaunay syndrome. COR ET VASA 2010. [DOI: 10.33678/cor.2010.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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75
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Gloviczki P. Union of forces. Phlebology 2010; 25:217-8. [DOI: 10.1258/phleb.2010.010e04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- P Gloviczki
- The Joe M. and Ruth Roberts Professor of Surgery, Division of Vascular and Endovascular Surgery and Director, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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76
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Dubois J, Alison M. Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 2010; 40:895-905. [PMID: 20432007 DOI: 10.1007/s00247-010-1621-y] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 02/08/2010] [Indexed: 01/19/2023]
Abstract
Most haemangiomas and vascular malformations are identified according to clinical criteria. A good knowledge of the classification and clinical characteristics of the vascular anomalies is necessary when managing these patients. However, some cases are challenging either because of an atypical presentation (e.g., soft-tissue mass with normal overlying skin) or because of classification difficulties. Doppler US and MRI are the two main imaging modalities that allow classification of the vascular anomalies and are useful in those clinically uncertain cases to establish the correct diagnosis. This aids the choice of the most appropriate treatment and to inform the parents of the prognosis. High-resolution grey-scale and Doppler US allow excellent visualization of most superficial masses. Doppler US is the easiest way to assess the haemodynamics of a vascular lesion and to clarify a doubtful diagnosis between a haemangioma and vascular malformation. MRI is the best technique for evaluating the extent of the lesions and their relationship to adjacent structures. While newly developed drugs from angiogenesis research labs are awaited, radiologists have an important role in the treatment of haemangiomas and vascular malformations. Intervention remains crucial in cases of alarming haemangiomas and venous malformations (VM), lymphatic malformations (LM) and arteriovenous malformations (AVM). A multidisciplinary team, including paediatricians, haematologists, surgeons and radiologists, must manage the problem cases both in terms of diagnostic work-up and therapeutic options. This paper will briefly discuss the imaging findings and treatment of vascular anomalies.
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Affiliation(s)
- Josée Dubois
- Department of Medical Imaging, Sainte-Justine Hospital, 3175 Cote Ste-Catherine, Montreal, QC H3T 1C5, Canada.
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Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations. AJR Am J Roentgenol 2010; 194:W439-44. [PMID: 20410391 DOI: 10.2214/ajr.09.3416] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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78
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Samimi M, Lorette G. Syndrome de Klippel-Trenaunay. Presse Med 2010; 39:487-94. [DOI: 10.1016/j.lpm.2009.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/13/2009] [Accepted: 10/14/2009] [Indexed: 01/19/2023] Open
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Control of disseminated intravascular coagulation in Klippel-Trenaunay-Weber syndrome using enoxaparin and recombinant activated factor VIIa: a case report. J Med Case Rep 2010; 4:92. [PMID: 20302608 PMCID: PMC2848681 DOI: 10.1186/1752-1947-4-92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 03/19/2010] [Indexed: 01/19/2023] Open
Abstract
Introduction Vascular malformation is associated with coagulopathies, especially when hemostasis is challenged. Case presentation We present the case of an 11-year-old Hispanic girl with Klippel-Trenaunay-Weber syndrome that developed disseminated intravascular coagulation after minor surgery, which was controlled by blood product transfusions and enoxaparin to address an ongoing consumptive coagulopathy. The patient, however, developed bacteremia and liver trauma that resulted in severe bleeding. To the best of our knowledge, we report here the first known instance of administering recombinant coagulation factor VIIa to control acute bleeding in a patient with Klippel-Trenaunay-Weber syndrome. Conclusions This case illustrates the concept of enoxaparin maintenance to suppress an ongoing consumptive coagulopathy and the use of recombinant coagulation factor VIIa to control its potentially fatal severe bleeding episodes.
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80
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Lee BB, Villavicencio JL. Primary lymphoedema and lymphatic malformation: are they the two sides of the same coin? Eur J Vasc Endovasc Surg 2010; 39:646-53. [PMID: 20176496 DOI: 10.1016/j.ejvs.2010.01.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 01/25/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clear the confusion regarding the relationship between the 'primary lymphoedema' and (truncular) lymphatic malformation (LM); the latter is one of congenital vascular malformations. MATERIALS & METHODS A literature review was carried out on the primary lymphoedema either existing as an independent LM lesion or as a component of the Klippel-Trenaunay syndrome. RESULTS The review was able to provide a contemporary guide/conclusion on the definition and classification, clinical evaluation and clinical management regarding conservative (physical) therapy, reconstructive surgical therapy and ablative/excisional surgical therapy, for the primary lymphoedema as an LM. CONCLUSIONS Primary lymphoedema can be considered as 'congenital' since its majority represents a clinical manifestation of the truncular type of LM arising during the later stages of lymphangiogenesis. Such embryological staging information of the LM is critical for proper management of the primary lymphoedema when it exists with other congenital vascular malformations (Klippel-Trenaunay syndrome). 2. Basic non-invasive to minimally invasive tests will provide an adequate diagnosis and lead to the correct multidisciplinary, specifically targeted and sequenced treatment strategy. 3. The mainstay of current management of the primary lymphoedema/truncular LM is complex decongestive therapy; and the reconstructive as well as ablative surgical therapy remain adjunctive therapies at best.
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Affiliation(s)
- B B Lee
- Division of Vascular Surgery, Georgetown University School of Medicine, Washington, DC 20007, USA.
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81
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Zea MI, Hanif M, Habib M, Ansari A. Klippel-Trenaunay Syndrome: a case report with brief review of literature. J Dermatol Case Rep 2009; 3:56-9. [PMID: 21886734 DOI: 10.3315/jdcr.2009.1038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/20/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Tranuanay Syndrome is a rare sporadic disease characterized by clinical triad of capillary malformation; soft tissue and bony hypertrophy; and atypical varicosity. Although this syndrome was first described more than hundred years ago, exact incidence has not been estimated yet. Several theories have been postulated to describe its pathogenesis. Clinical presentation of this syndrome is protean ranging from minimal asymptomatic disease to life threatening bleeding and embolism. Management of this syndrome includes careful diagnosis, prevention and treatment of complications. MAIN OBSERVATION We are presenting a case of Klippel-Tranuanay Syndrome in a 19-year-old male patient presenting with varicosity in lateral aspect of right leg. On careful examination other components of the syndrome were found. Patient was kept on yearly follow up. CONCLUSION Usually patients with Klippel-Tranuanay Syndrome present with complication. This case shows that there is also a need for medical solutions in patients who seek advise for cosmetic reasons.
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Affiliation(s)
- Mohammad Iqbal Zea
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh, U P, 202002, India
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Bogue CO, John PR, Connolly BL, Rea DJ, Amaral JG. Symptomatic caval penetration by a Celect inferior vena cava filter. Pediatr Radiol 2009; 39:1110-3. [PMID: 19588133 DOI: 10.1007/s00247-009-1340-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 05/27/2009] [Accepted: 06/05/2009] [Indexed: 11/25/2022]
Abstract
We report a case of penetration of the inferior vena cava (IVC) by all four primary struts of a Celect caval filter in a 17-year-old girl with Klippel-Trénaunay syndrome. The girl presented with acute lower abdominal and right leg pain 17 days after filter insertion. An abdominal radiograph demonstrated that the filter had moved caudally and that the primary struts had splayed considerably since insertion. Contrast-enhanced CT confirmed that all four primary struts had penetrated the IVC wall. There was a small amount of retroperitoneal hemorrhage. The surrounding vessels and viscera were intact. The filter was subsequently retrieved without complication.
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Affiliation(s)
- Conor O Bogue
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto M5G 1X8, ON, Canada.
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Villela ALC, Guedes LGS, Paschoa VVA, David AB, Tenório TM, Lamego Junior HP, Guedes Neto HJ, Caffaro RA. Perfil epidemiológico de 58 portadores de síndrome de Klippel-Trénaunay-Weber acompanhados no Ambulatório da Santa Casa de São Paulo. J Vasc Bras 2009. [DOI: 10.1590/s1677-54492009000300006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
CONTEXTO: A síndrome de Klippel-Trénaunay-Weber é uma doença rara sobre a qual encontramos poucos artigos na literatura (geralmente relatos de casos esporádicos relacionados a complicações). OBJETIVO: Avaliar o perfil epidemiológico dos portadores da referida síndrome. MÉTODOS: Foram copilados dados dos prontuários de 58 pacientes acompanhados no ambulatório de doenças linfáticas e angiodisplasias da disciplina de Cirurgia Vascular da Faculdade de Ciências Médicas da Santa Casa de São Paulo. RESULTADOS: A distribuição foi igual entre homens e mulheres (30 homens e 28 mulheres). A idade média dos pacientes em tratamento foi de 12,8 anos. Na maioria dos casos, a doença foi diagnosticada na infância, sendo a mancha em vinho do porto o primeiro sinal notado pela família, no nascimento ou primeiro ano de vida. O sintoma mais referido foi a dor, normalmente relacionada aos sintomas de estase venosa, sendo o sintoma considerado debilitante. Pela classificação CEAP, encontramos as crianças nas classes C0 e C1 e a maioria dos adultos nas classes avançadas. Foi diagnosticada a presença de fístulas arteriovenosas em 8,5% dos casos. Apenas 6,8% referiram história familiar. CONCLUSÃO: A síndrome de Klippel-Trénaunay e a síndrome de Parkes Weber são apresentações diferentes de uma única enfermidade e podem ser estudadas conjuntamente como síndrome de Klippel-Trénaunay-Weber. O melhor momento para reconhecer os portadores e poder amenizar a progressão de insuficiência venosa, hipertrofia óssea e tecidos moles é a infância. O tratamento compressivo deve ser indicado a todos os portadores com o intuito de diminuir a evolução da doença venosa periférica.
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Direct CT venography for evaluation of the lower extremity venous anomalies of Klippel-Trenaunay Syndrome. AJR Am J Roentgenol 2009; 192:W311-6. [PMID: 19457795 DOI: 10.2214/ajr.08.1151] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Our aim was to describe the technique of direct CT venography and to describe various forms of venous anomalies detected with CT venography in patients with Klippel-Trénaunay syndrome. CONCLUSION MDCT is helpful for visualizing the full length of extremities and for evaluating length and thickness on one image.
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Matsubara M, Tanikawa H, Mogami Y, Shibata S, Uchiyama S, Kato H. Carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve in Klippel-Trénaunay syndrome. A case report. J Bone Joint Surg Am 2009; 91:1223-7. [PMID: 19411473 DOI: 10.2106/jbjs.h.00813] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mitsuhiro Matsubara
- Department of Orthopaedic Surgery, Azumi General Hospital, Kitaazumi-County, Nagano, Japan
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Blei F. Literature Watch. Lymphat Res Biol 2008. [DOI: 10.1089/lrb.2008.6203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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