1
|
Hammer S, da Silva NPB, Müller J, Fellner C, Greiner B, Ingrid Huf V, Stroszczynski C, Wohlgemuth WA, Uller W. Structured magnetic resonance imaging-based characterization of the marginal vein reveals limits of the Weber-classification. VASA 2023. [PMID: 37082826 DOI: 10.1024/0301-1526/a001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: The marginal vein (MV) is a persisting embryonic vein located at the lateral aspect of the lower limb. The Weber-classification, which was developed on the basis of phlebography in the 1990s, is the only existing classification system for this rare disease. Aim of this study was the structured characterization of the lateral marginal vein (MV) using magnetic resonance imaging (MRI) and evaluation of the applicability of the Weber-classification. Patients and methods: Institutional Review Board approval was obtained for this retrospective, single-center study. All patients who underwent contrast-enhanced MRI (using a prospectively determined protocol) of the untreated MV were included. MV anatomy and associated findings were characterized in a structured way taking into account the criteria of the Weber-classification for MV: inflow, outflow and extension. If three criteria of the Weber-classification were fulfilled the MV was categorized as "classifiable according to Weber". The MV was categorized as "partially classifiable according to Weber", if two criteria were met and as "not classifiable according to Weber" if less than two criteria were applicable. Results: 56 imaging studies of 58 MV (7 thoracoabdominal, 51 lower extremities) were reviewed. 18/51 MV of the lower extremities were "classifiable" according to the Weber-classification. 33/51 lower extremity MV were not definitely categorized according to the Weber-classification: 19/51 MV were "partially classifiable" and 14/51 MV were "not classifiable". 30/51 MV presented with hypoplastic, 1/51 with aplastic deep venous system. 34/51 lower extremity and 6/7 thoracoabdominal MV were associated with an additional vascular malformation (VM). Conclusions: MRI is suitable for detailed anatomic characterization of the MV and reveals additional therapy relevant findings like associated VM. The Weber-classification was not applicable in most cases, reflecting its limits and the heterogeneity of this rare disease. Structured reports rather than an obsolete classification system should be preferred for MRI of the MV.
Collapse
Affiliation(s)
- Simone Hammer
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Natascha Platz Batista da Silva
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Johanna Müller
- Department of Internal Medicine, Hospital Barmherzige Brüder, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Barbara Greiner
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Veronika Ingrid Huf
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Christian Stroszczynski
- Department of Radiology, Medical Center University of Regensburg, Faculty of Medicine, University Hospital Regensburg, Germany
| | - Walter Alexander Wohlgemuth
- Department of Radiology, Medical Center University of Halle (Saale), Faculty of Medicine, University of Halle (Saale), Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
2
|
Klippel–Trenaunay Syndrome: Employment of a New Endovascular Treatment Technique—Mechanochemical Ablation Using the Flebogrif System. J Clin Med 2022; 11:jcm11185255. [PMID: 36142903 PMCID: PMC9503983 DOI: 10.3390/jcm11185255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 01/19/2023] Open
Abstract
Background: Klippel–Trenaunay syndrome (KTS) is characterized by a triad of symptoms; varicose veins and venous malformations (VMs), capillary malformations (port-wine stain), and soft tissue and bone hypertrophy. Herein, we retrospectively studied six patients with KTS who underwent treatment with the Flebogrif system and evaluated their outcomes. Methods: Six KTS patients aged 16–22 years who had undergone 18 non-thermal ablations using the Flebogrif system were enrolled. All patients underwent multistage foam sclerotherapy with 3% polidocanol at 3–4-week intervals. Results: Venous clinical severity score (VCSS) analysis showed improvement in the patients’ clinical condition. All patients reported a significant improvement in aesthetic outcomes. One patient presented with recanalization of ablated marginal veins during the 24-month follow-up period. Patients could return to full activity within 7–10 days after the procedure. None of the patients experienced serious systemic complications. Conclusion: The use of the Flebogrif system in treating various forms of chronic venous insufficiency, including in patients with KTS, provides a high success rate with a high closure rate.
Collapse
|
3
|
LEE BB, VAGHI M. Review on target treatment of Klippel-Trenaunay Syndrome. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01500-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
4
|
Lambert G, Teplisky D, Cabezas M, Szhafir I, Silva M, Garriga M, Oliva A, Sierre S. Mechanochemical Endovenous Ablation of Varicose Veins in Pediatric Patients with Klippel-Trénaunay Syndrome: Feasibility, Safety, and Initial Results. J Vasc Interv Radiol 2020; 32:80-86. [PMID: 33139184 DOI: 10.1016/j.jvir.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS). MATERIALS AND METHODS Thirteen MOCA procedures were performed in 11 patients (age range, 4-16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6-25 months). RESULTS Technical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period. CONCLUSIONS MOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.
Collapse
Affiliation(s)
- Gonzalo Lambert
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Darío Teplisky
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Mariela Cabezas
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Ioná Szhafir
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Mauricio Silva
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Matías Garriga
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Alejandro Oliva
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina
| | - Sergio Sierre
- Department of Interventional Radiology, Hospital de Pediatría Prof. J. P. Garrahan, Combate de los Pozos 1881 (1245), Buenos Aires, Argentina.
| |
Collapse
|
5
|
Klippel-Trenaunay Syndrome Involving Upper Limb and Chest Wall: A Case Report and Review of the Literature. ACTA MEDICA BULGARICA 2020. [DOI: 10.2478/amb-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
The group of congenital limb overgrowth syndromes associated with vascular malformations include various disorders, often with variable clinical expression. Klippel-Trenaunay syndrome is the most common syndrome in this group, compared to other similar disorders such as Proteus, Parkes-Weber, Sturge-Weber, Cobb, Maffucii and CLOVES syndromes. We present a case of a 55-year-old male who presented with swelling, pain, heaviness, numbness and increased local temperature, involving the right upper extremity and the right side of the chest wall and associated with a livid erythema. The patient had several comorbidities including arterial hypertension and ischemic heart disease. He also had a family history of diabetes mellitus. A multidisciplinary team-based treatment approach, including physicians with expertise in various medical and surgical specialties was applied with the patient being “the unifying focus” of all these experts and their efforts. A personal approach tailored to the patient’s preferences was the key to a successful treatment.
Collapse
|
6
|
Fereydooni A, Nassiri N. Evaluation and management of the lateral marginal vein in Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. J Vasc Surg Venous Lymphat Disord 2020; 8:482-493. [PMID: 32089498 DOI: 10.1016/j.jvsv.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/16/2019] [Indexed: 01/19/2023]
Abstract
The lateral marginal vein is an anomalous clinical entity found in association with Klippel-Trénaunay and other PIK3CA-related overgrowth syndromes. Although it is reported to affect <20% of patients with Klippel-Trénaunay syndrome, this venous anomaly has been associated with significant morbidity and mortality attributable to venous hypertension and potentially lethal thromboembolic events. Limited literature exists on the diagnosis and management of this rare anomaly, with most of the reports focusing on retrospective clinical experience at a few centers of excellence. Despite these limitations, a systematic approach to diagnosis and treatment of this anomaly is warranted and expounded on herein. When plausible, clinical recommendations based on best available literature are made.
Collapse
Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
| |
Collapse
|
7
|
Radiofrequency Ablation of the Marginal Venous System in Patients with Venous Malformations. Cardiovasc Intervent Radiol 2018; 42:213-219. [DOI: 10.1007/s00270-018-2099-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/16/2018] [Indexed: 11/26/2022]
|
8
|
Wang SK, Drucker NA, Gupta AK, Marshalleck FE, Dalsing MC. Diagnosis and management of the venous malformations of Klippel-Trénaunay syndrome. J Vasc Surg Venous Lymphat Disord 2018. [PMID: 28624001 DOI: 10.1016/j.jvsv.2016.10.084] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A dearth of information exists in the literature regarding current practice in the management of Klippel-Trénaunay syndrome (KTS), a rare condition. We review and describe the etiology, diagnosis, and treatment of KTS. METHODS Relevant data were synthesized from a Medline review using a combination of the keyterms "Klippel" and "Trénaunay." The majority of hits described singular case reports and were subsequently excluded. The remaining papers were then reviewed and included on the basis of the quality of evidence and the authors' discretion. CONCLUSIONS KTS is characterized by a clinical triad of extremity varicosities, cutaneous vascular malformations, and hypertrophy of soft tissues and long bones. The diagnosis is clinically supplemented with magnetic resonance imaging and computed tomography. Although this syndrome is associated with significant comorbidities, such as pain, edema, ulcerations, and pruritus, it is rarely the cause of death. The backbone of treatment is nonoperative in nature but should be supplemented with minimally invasive, endovascular, and rarely open surgical procedures for refractory cases.
Collapse
Affiliation(s)
- S Keisin Wang
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Natalie A Drucker
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Alok K Gupta
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | | | - Michael C Dalsing
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind; Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, Ind.
| |
Collapse
|
9
|
Transcatheter embolization of persistent embryonic veins in venous malformation syndromes. J Vasc Surg Venous Lymphat Disord 2017; 5:749-755. [DOI: 10.1016/j.jvsv.2017.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/01/2017] [Indexed: 01/19/2023]
|
10
|
Efficacy of Endovascular Radiofrequency Ablation for Thromboangiitis Obliterans (Buerger's Disease). Ann Vasc Surg 2017; 42:78-83. [DOI: 10.1016/j.avsg.2016.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 01/04/2023]
|
11
|
Volz KR, Kanner CD, Evans J, Evans KD. Klippel-Trénaunay Syndrome: Need for Careful Clinical Classification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2057-2065. [PMID: 27492391 DOI: 10.7863/ultra.15.08007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/20/2015] [Indexed: 06/06/2023]
Abstract
Klippel-Trénaunay syndrome (KTS) is a rare congenital malformation characterized by a triad of clinical presentations: (1) capillary malformations manifesting as a "port wine stain"; (2) limb hypertrophy; and (3) venous varicosities. It is distinguished from Parkes-Weber syndrome by the absence of substantial arteriovenous shunting. Due to the clinical implications of an arteriovenous fistula, differentiation between the two syndromes is important, as the prognosis and treatment greatly differ. We present a series of 5 cases of suspected KTS, while emphasizing the difficulties in distinguishing KTS from Parkes-Weber syndrome without diagnostic imaging and underscoring the importance of accurately classifying patients with the appropriate syndrome.
Collapse
Affiliation(s)
- Kevin R Volz
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
| | - Christopher D Kanner
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
| | - Julie Evans
- Division of Vascular Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio USA
| | - Kevin D Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, College of Medicine, Columbus, Ohio USA
| |
Collapse
|
12
|
Nassiri N, Thomas J, Cirillo-Penn NC. Evaluation and management of peripheral venous and lymphatic malformations. J Vasc Surg Venous Lymphat Disord 2016; 4:257-65. [DOI: 10.1016/j.jvsv.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/02/2015] [Indexed: 12/18/2022]
|
13
|
Martino V, Ferrarese A, Alessandro B, Bullano A, Marola S, Surace A, Gentile V, Bindi M, Solej M, Enrico S. An unusual evolution of a case of Klippel-Trenaunay syndrome. Open Med (Wars) 2015; 10:498-501. [PMID: 28352743 PMCID: PMC5368873 DOI: 10.1515/med-2015-0084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder. KTS can be diagnosed on the basis of any 2 of 3 features: cutaneous capillary malformations, soft tissue or bony hypertrophy and varicose veins. We present an unusual case of KTS complicated by an infection of venous ulcers of the lower limb by larvae. The treatment of infection was a complete debridement; however baseline treatment of KTS is still in evaluation.
Collapse
Affiliation(s)
- Valter Martino
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano - Turin ( Italy )
| | - Alessia Ferrarese
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Borello Alessandro
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Alberto Bullano
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Valentina Gentile
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin
| |
Collapse
|
14
|
Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, de Wolf M, Eggen C, Giannoukas A, Gohel M, Kakkos S, Lawson J, Noppeney T, Onida S, Pittaluga P, Thomis S, Toonder I, Vuylsteke M, Kolh P, de Borst GJ, Chakfé N, Debus S, Hinchliffe R, Koncar I, Lindholt J, de Ceniga MV, Vermassen F, Verzini F, De Maeseneer MG, Blomgren L, Hartung O, Kalodiki E, Korten E, Lugli M, Naylor R, Nicolini P, Rosales A. Editor's Choice - Management of Chronic Venous Disease: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2015; 49:678-737. [PMID: 25920631 DOI: 10.1016/j.ejvs.2015.02.007] [Citation(s) in RCA: 501] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
15
|
Sermsathanasawadi N, Hongku K, Wongwanit C, Ruangsetakit C, Chinsakchai K, Mutirangura P. Endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy in treatment of klippel-trenaunay syndrome. Ann Vasc Dis 2014; 7:52-5. [PMID: 24719663 DOI: 10.3400/avd.oa.13-00111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 01/26/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Klippel-Trenaunay syndrome is composed of port-wine stain, limb hypertrophy and varicose veins. METHODS The two patients with Klippel-Trenaunay syndrome treated by endovenous radiofrequency thermal ablation and ultrasound-guided foam sclerotherapy of the abnormal veins was conducted. RESULTS Radiofrequency thermal ablation resulted in successful occlusion of the incompetent anterior accessory great saphenous vein. Moreover, ultrasound-guided foam sclerotherapy showed complete occlusion of the residual veins. At 6 month follow-up, both patients markedly decreased leg symptoms including pain, cramping, limb swelling, and bulging of veins. CONCLUSION Radiofrequency thermal ablation combined with foam sclerotherapy is a minimally invasive procedure alternative to the standard invasive surgery and can be the option for saphenous ablation in Klippel-Trenaunay syndrome patients.
Collapse
Affiliation(s)
- Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chumpol Wongwanit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanean Ruangsetakit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramook Mutirangura
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
16
|
Pavlović MD, Schuller-Petrović S, Pichot O, Rabe E, Maurins U, Morrison N, Pannier F. Guidelines of the First International Consensus Conference on Endovenous Thermal Ablation for Varicose Vein Disease--ETAV Consensus Meeting 2012. Phlebology 2014; 30:257-73. [PMID: 24534341 DOI: 10.1177/0268355514524568] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Endovenous thermal ablation (ETA) procedures are catheter-directed, ultrasound (US)-guided thermal methods for treatment in varicose veins disease. Radiofrequency, laser or steam energy thermally denatures vein wall collagen, leading first to vein wall inflammation, then fibrosis and finally to occlusion. The aim of this guideline is to give evidence-based recommendations for ETA procedures. METHODS These guidelines were drafted during a consensus meeting of a group of experts in the field of ETA in June 2012 (Hvar, Croatia) under the auspices of the International Union of Phlebology (IUP). These guidelines review the present state of knowledge as reflected in peer-reviewed published medical literature. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. RESULTS Recommendations on the use of ETA procedures were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. Health economics were not considered, since differences in national health systems and pricing make it difficult to form general conclusions that are relevant at an international level.
Collapse
Affiliation(s)
- Miloš D Pavlović
- Dermatology Centre Parmova & DCP-Venex Centre, Ljubljana, Slovenia
| | | | | | - Eberhard Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | | | | | | |
Collapse
|
17
|
Demertzis JL, Kyriakos M, Loomans R, McDonald DJ, Wessell DE. Synovial hemangioma of the hip joint in a pediatric patient. Skeletal Radiol 2014; 43:107-13. [PMID: 24061493 DOI: 10.1007/s00256-013-1724-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/21/2013] [Accepted: 08/25/2013] [Indexed: 02/02/2023]
Abstract
Hemangiomas of the articular synovium are rare and commonly associated with recurrent joint swelling and painful limitation of motion. The knee joint is the most commonly involved site, with most patients diagnosed in the second to third decade of life. Although over 200 cases have been reported in the English-language medical literature, only three have originated within the hip joint, all of which were in adult patients reported in the surgical literature. We describe a histologically proven synovial hemangioma of the hip joint in a pediatric patient that invaded the femur, acetabulum, and adjacent soft tissues, with a detailed discussion of the differential diagnosis based on the radiographic and magnetic resonance imaging (MRI) findings.
Collapse
Affiliation(s)
- Jennifer L Demertzis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Campus Box 8131, St. Louis, MO, 63110, USA,
| | | | | | | | | |
Collapse
|
18
|
Harrison C, Holdstock J, Price B, Whiteley M. Endovenous radiofrequency ablation and combined foam sclerotherapy treatment of multiple refluxing perforator veins in a Klippel-Trenaunay syndrome patient. Phlebology 2013; 29:698-700. [PMID: 23868201 DOI: 10.1177/0268355513496991] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe an unusual pattern of venous abnormality and the use of endovenous radiofrequency ablation, using the TRans-Luminal Occlusion of Perforator technique to treat multiple refluxing perforators in a 29-year-old patient with Klippel-Trenaunay syndrome. Klippel-Trenaunay syndrome is a rare congenital anomaly characterised by a triad of features including unilateral limb overgrowth, venous varicosities and capillary malformations of the affected limb. Ultrasound findings demonstrated 22 incompetent perforator veins in the lateral aspect of the patients left leg, communicating with a complex network of large calibre varicosities causing unilateral leg oedema and pain. Staged radiofrequency ablation procedures using the Olympus Celon RFITT (radiofrequency-induced thermotherapy; please see Technical Note) device under local anaesthetic were performed. These procedures were followed with two sessions of foam sclerotherapy. This case report describes the efficacy of this treatment regime and this patient's significantly improved morbidity 18 months after initial treatment.
Collapse
Affiliation(s)
| | | | - Ba Price
- The Whiteley Clinic, Guildford, Surrey, UK
| | | |
Collapse
|
19
|
Nassiri N, O TMJ, Rosen RJ, Moritz J, Waner M. Staged endovascular and surgical treatment of slow-flow vulvar venous malformations. Am J Obstet Gynecol 2013; 208:366.e1-6. [PMID: 23395642 DOI: 10.1016/j.ajog.2013.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/21/2013] [Accepted: 02/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to report our experience in a rare series of treated symptomatic slow-flow vulvar venous malformations (VVMs) using a staged, multidisciplinary approach. STUDY DESIGN Consecutive patients with symptomatic lesions treated over a 7 year period (2005-2012) were followed up for technical success, resolution of symptoms, aesthetic outcomes, and complications. Direct endovenous sclerotherapy (DEVS) using sodium tetradecyl sulfate (STS) foam was performed in all patients under ultrasound and contrast-enhanced fluoroscopic guidance. Surgical excision and layered primary closure was performed within 24 hours after the last DEVS session. RESULTS Eleven patients (mean age, 25 years; range, 4-43 years) were treated. Presenting symptoms included pain (n = 11), soft tissue swelling (n = 11), local heaviness (n = 11), dyspareunia (n = 2), and dysmenorrhea (n = 2). Most were isolated lesions (n = 8). There were 2 cases of Klippel-Trénaunay syndrome and 1 case of Maffucci syndrome. The latter required Nd:YAG laser photocoagulation prior to sclerotherapy. On average, approximately 3 DEVS sessions were required prior to surgical excision (range, 1-6). Mean estimated surgical blood loss was 130 mL (range, 20-400 mL). Mean follow-up was 23 months (range, 3-55 months). Elimination of pain and soft tissue redundancy was achieved in all patients with satisfactory aesthetic outcomes. All patients experienced minor pain and swelling after DEVS. Following surgical excision, there was 1 case of hematoma and wound dehiscence requiring surgical evacuation. No other reinterventions, endovascular or surgical, were required. CONCLUSION VVMs require increased awareness and appropriate preoperative evaluation for proper identification and treatment. A multidisciplinary approach can provide improvement in clinical signs and symptoms with satisfactory cosmesis and minimal complications.
Collapse
Affiliation(s)
- Naiem Nassiri
- Lenox Hill Heart and Vascular Institute of New York, Lenox Hill Hospital, North Shore Long Island Jewish Health System, New York, NY, USA.
| | | | | | | | | |
Collapse
|
20
|
Yamaki T, Konoeda H, Fujisawa D, Ogino K, Osada A, Hamahata A, Nozaki M, Sakurai H. Prevalence of various congenital vascular malformations in patients with Klippel-Trenaunay syndrome. J Vasc Surg Venous Lymphat Disord 2012; 1:187-93. [PMID: 26992342 DOI: 10.1016/j.jvsv.2012.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/18/2012] [Accepted: 07/25/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Klippel-Trenaunay syndrome (KTS) is a condition defined by the association of three physical features: capillary malformation, varicosities, and hypertrophy of bony and soft tissues. However, KTS is characterized by congenital vascular malformations (CVMs) that are difficult to classify. Therefore, the present study was undertaken to analyze the various CVMs in patients with KTS. METHODS Sixty-one patients with KTS were enrolled, and their CVMs were divided into predominantly venous defects, predominantly lymphatic defects, and mixed vascular defects using the Hamburg Classification. Capillary malformations were subdivided into port-wine stain, telangiectasia, and angiokeratoma. Truncular and extratruncular vascular malformations were detected using duplex ultrasound and magnetic resonance imaging. Reflux in the superficial and deep venous systems was also evaluated. RESULTS Forty-five patients (74%) had predominantly venous defects, four (6%) had predominantly lymphatic defects, and 12 (20%) had mixed vascular defects. Capillary malformations were detected in 54 patients (89%), among which port-wine stain was the most predominant (40 patients, 66%), followed by telangiectasia (31 patients, 51%) and angiokeratoma (18 patients, 30%). Extratruncular venous malformations were detected in 47 patients (77%). In contrast, truncular venous malformations were found in 50 patients (82%). Among these, embryonic lateral marginal vein showed the highest occurrence, accounting for 53% (32 patients). However, reflux in this vein was detected in only nine patients (15%). Twelve patients (20%) had reflux in the great saphenous vein, and four (7%) had reflux in the small saphenous vein. Deep vein hypoplasia was found in seven patients (12%), and only five patients (8%) had deep vein aplasia. Extratruncular lymphatic malformations were found in 13 patients (21%) and truncular lymphatic malformations in 17 (28%). CONCLUSIONS Patients with KTS have a variety of CVMs, but both extratruncular and truncular venous malformations continue to be targets for intervention.
Collapse
Affiliation(s)
- Takashi Yamaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hisato Konoeda
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kota Ogino
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuyoshi Osada
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsumori Hamahata
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Motohiro Nozaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
21
|
Diagnosis and management of extensive vascular malformations of the lower limb: part II. Systemic repercussions [corrected], diagnosis, and treatment. J Am Acad Dermatol 2011; 65:909-23; quiz 924. [PMID: 22000871 DOI: 10.1016/j.jaad.2011.03.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
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. Extensive vascular malformations are often more complex than they appear and require a multidisciplinary therapeutic approach. Vascular malformations may be associated with underlying disease or systemic anomalies. Part II of this two-part series on the diagnosis and management of extensive vascular malformations of the lower limb highlights the systemic repercussions [corrected] (bone, articular, visceral, and hematologic involvement), diagnosis, and treatment of these lesions.
Collapse
|
22
|
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.
Collapse
|
23
|
Wiwanitkit V. Radio-frequency stylet ablation for incompetent perforating veins. Phlebology 2011; 26:48. [PMID: 21239726 DOI: 10.1258/phleb.2009.009091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
24
|
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
|
25
|
Alomari AI. Diversion venography--a modified technique in Klippel-Trenaunay syndrome: initial experience. J Vasc Interv Radiol 2010; 21:685-9. [PMID: 20227297 DOI: 10.1016/j.jvir.2010.01.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 09/06/2009] [Accepted: 01/19/2010] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To evaluate an initial experience with diversion venography, a modified venographic technique, to assess the deep venous system in patients with Klippel-Trenaunay syndrome (KTS). MATERIALS AND METHODS Eight patients with KTS underwent diversion venography of the affected lower extremities. The technique of diversion venography included the use of multiple methods to divert blood flow into the deep venous system, such as application of multiple tourniquets, cannulation of the tibial and popliteal veins, multiple imaging projections, and temporary endoluminal occlusion of the lateral venous system. All studies were done under general anesthesia before surgical or interventional procedures. RESULTS The technique of diversion venography was successful in opacifying the deep venous system in all eight patients studied. No complications were encountered. CONCLUSIONS Diversion venography successfully visualizes the deep venous system in patients with KTS. This can potentially expand the treatment options for these patients.
Collapse
Affiliation(s)
- Ahmad I Alomari
- Division of Vascular and Interventional Radiology, Children's Hospital Boston, Boston, MA 02115, USA.
| |
Collapse
|
26
|
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.
Collapse
|
27
|
Current world literature. Curr Opin Ophthalmol 2009; 20:333-41. [PMID: 19535964 DOI: 10.1097/icu.0b013e32832e478f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
28
|
Literature Watch. Lymphat Res Biol 2008. [DOI: 10.1089/lrb.2008.63411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Minimally invasive vein therapy and treatment options for endovenous heat-induced thrombus. JOURNAL OF VASCULAR NURSING 2008; 26:53-7. [PMID: 18492558 DOI: 10.1016/j.jvn.2008.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Radiofrequency ablation and endovenous laser therapy are types of minimally invasive techniques that have been used in the treatment of chronic venous insufficiency. In both procedures, high-intensity heat via thermal energy is produced and delivered via an endovenous catheter placed in the saphenous vein. This results in changes that therapeutically induce closure of the vein by denaturing the vessel wall with subsequent thrombus formation. Patients undergo ultrasound 48 to 72 hours postprocedure to confirm vessel occlusion and assess for possible extension of thrombus into the deep venous system. Thrombus is frequently visualized with the procedure in the tributaries, the venous dilations, and at times the saphenofemoral junction. In any other setting, thrombus at the saphenofemoral junction would warrant anticoagulation. However, the characteristics, composition, and behavior of endovenous heat-induced thrombus are different than de novo thrombosis. This postprocedure endovenous heat-induced thrombus is considered a normal consequence of the procedure and does not require traditional anticoagulation in most cases, depending on the location.
Collapse
|