An unusual presentation of Ehlers-Danlos syndrome vascular type with deep vein thrombosis: A case for multidisciplinary management

Importance of comprehensive genetic testing for patients with suspected vascular Ehlers-Danlos syndrome: a family case report and literature review

Vascular Ehlers-Danlos syndrome (vEDS), the most severe type of Ehlers-Danlos syndrome, is caused by an autosomal-dominant defect in the COL3A1 gene. In this report, we describe the clinical history, specific phenotype, and genetic diagnosis of a man who died of vEDS. The precise diagnosis of this case using whole-exome sequencing provided solid evidence for the cause of death, demonstrating the practical value of genetic counseling and analysis. Early diagnosis for the proband's son, who was also affected by vEDS, revealed initial complications of vEDS in early childhood, which have rarely been reported. We also reviewed the literature on COL3A1 missense mutations and related phenotypes. We identified an association between digestion tract events and non-glycine missense variants, which disproves a previous hypothesis regarding the genotype-phenotype correlation of vEDS. Our results demonstrate the necessity of offering comprehensive genetic testing for every patient suspected of having vEDS.

Familial hepatic rupture in vascular Ehlers-Danlos syndrome in pregnancy with atypical thromboses

This case highlights the importance of genetic testing over fibroblast testing and presents the first published thromboelastometry data in vascular Ehlers-Danlos syndrome.

Anterior tibial artery rupture treated using covered stent in a patient with vascular Ehlers-Danlos syndrome

Vascular Ehlers-Danlos syndrome (vEDS) is a rare degenerative connective tissue disease caused by a mutation of the COL3A1 gene that results in systemic vascular fragility. Arterial rupture is a potentially fatal serious complication that is the most commonly reported cause of death among patients with this disease, as ruptured vessels remain fragile even after surgical or endovascular reconstruction. Therefore, treatment for vascular complications in patients with vEDS remains controversial. Rupture or pseudoaneurysm of the infrapopliteal artery is extremely rare. We describe a 38-year-old woman with vEDS who presented with sudden widespread rupture of the anterior tibial artery. She was treated by endovascular reconstruction using covered stents. She has remained free of vascular events for two years after surgery, and the course has been uneventful. Endovascular reconstruction using covered stents might offer an alternative for relatively small ruptured arteries and avoid disturbing blood flow in the lower extremities of patients with vEDS. <Learning objective: Vascular Ehlers-Danlos syndrome (vEDS) causes systemic vascular fragility that results in arterial rupture. However, rupture of the arteries in the lower extremities is rare, and definitive treatment has not been established. Endovascular reconstruction with covered stents might offer an alternative treatment for ruptured arteries in the lower extremities of patients with vEDS.>.

Treatment of vascular Ehlers-Danlos syndrome: a systematic review

OBJECTIVE

To provide the collected evidence from all literature reports.

BACKGROUND

Vascular Ehlers-Danlos syndrome (EDS) is a rare connective tissue disorder with serious hemorrhagic consequences. Most experience on treatment is based on case reports and small case series.

METHOD

A systematic literature review was performed. PubMed and reference lists were scrutinized.

RESULTS

A total of 231 patients were identified with no gender preponderance. Aneurysms were present in 40%, often multiple. In 33%, there was an arterial rupture without an underlying aneurysm. Carotidocavernous fistula was seen in 18%. After open surgery the mortality was 30%; after endovascular procedures, it was 24%; in a group of miscellaneous cases, it was 60%; and the overall mortality was 39%. The median age of patients at death was 31 years. The median follow-up time was 12 months (5 days-7 years), but in 20% cases, it was not reported. In only 29 of the 119 recent patients (24%) the mutation was verified with molecular genetic testing.

CONCLUSIONS

Vascular EDS is a serious disorder with high mortality, which does not seem to have been influenced by new treatment methods. Invasive methods should be used only when necessary, primarily to save the patients' life. Whenever possible, the genetic molecular defect should be identified. The results of this review may be affected by publications bias. Ideally, a prospective registry should be created.

Acute first onset of Ehlers–Danlos Syndrome type 4 with spontaneous rupture of posterior tibial artery pseudoaneurysm

Ehlers–Danlos syndrome type 4, the vascular type, is a rare, life-threatening inherited disorder of the connective tissue. Affected patients are at risk of arterial, bowel and uterine rupture during pregnancy. Generally, this syndrome remains undiagnosed until a sudden, acute presentation with organ rupture, and results in premature death, even if the patients survive the first and second major complications. An early diagnosis with genetic assays can help to plan the best treatment, which is often challenging due to the frailty of the arterial tissue. We report on a 28-year-old lady who presented with spontaneous rupture of a pseudoaneurysm of the posterior tibial artery.