The Klippel-Trenaunay syndrome associated with renal artery aneurysm

Nosological Consideration of Arterial Aneurysms Associated with Klippel-Trenaunay Syndrome

Klippel–Trenaunay syndrome (KTS) is a rare slow-flow combined vascular malformation characterized by capillary-lymphatic-venous lesions with soft tissue overgrowth of the limbs. We report the case of a 37-year-old female KTS patient with a deep femoral arterial aneurysm. We finally diagnosed that the aneurysm had resulted from a fundamental defect in the arterial wall structure. We discuss whether the use of “aneurysm associated with KTS” is accurate and how to better classify this type of capillary-venous lesion in 17 reported KTS patients with arterial aneurysms. In this review, we describe nosological problems of arterial aneurysms associated with KTS.

Klippel-Trénaunay-Weber syndrome associated with abdominal aortic aneurysm in childhood

Klippel-Trénaunay-Weber syndrome (KTWS), also known as angioosteohypertrophy syndrome, is a rare congenital malformation with unknown etiology characterized by the combination of capillary malformations (port-wine strain), venous varicosities, and a soft tissue or bony hypertrophy of the affected limb. It is known to be rarely associated with abdominal aortic aneurysm (AAA) in adults. We report the first published case of KTWS and a rapidly progressing symptomatic AAA undergoing open repair in a child. This underlines the importance of AAA screening and treatment rather than surveillance in patients with KTWS.

Multifocal intradural spinal AVF and renal artery aneurysms in a case of Klippel Trenaunay Syndrome (KTS)

We report an interesting case of a young patient who had hypertrophy of right leg and nevoid geographic skin lesion on the dorsal aspect of the right foot and leg suggestive of Klippel Trenaunay syndrome (KTS) and who presented for spinal digital subtraction angiography (DSA) to investigate the cause of progressive weakness of bilateral lower limbs. DSA revealed spinal arteriovenous fistulae (AVFs) at 3 levels and bilateral renal artery aneurysms. Although multiple intradural spinal cord AVFs and renal artery aneurysms are considered a feature of KTS, their clear demonstration in a single case either alone or together is not available in literature to the best of this author's knowledge. Existence of multifocal intradural fistulae in KTS calls for a detailed and complete spinal DSA even after a fistula is detected.

Intracranial aneurysms in klippel-trenaunay/weber syndromes: case report

OBJECTIVE

We present a comprehensive review of intracranial aneurysms in Klippel-Trenaunay and Klippel-Trenaunay-Weber syndromes (KTS/KTWS), and examine factors influencing the risks of surgery vs conservative management.

CLINICAL PRESENTATION

A 58-year-old physician with KTS affecting the right extremities presented with left hemispheric cerebellar stroke and was discovered to harbor four intracranial aneurysms of the posterior circulation: fusiform mid and distal BA (2.6 x 2 x 2 cm), fusiform right proximal P1 (2 x 1.3 x 1.3 cm), fusiform right distal P1 (2.8 x 2.7 x 2 cm), and saccular left distal posterior inferior cerebellar artery (2.5 x 2.5 x 2.5 cm). Ten years later he had an infarct in the paramedian distribution of the basilar artery and a right internal capsule stroke. Two months later, he developed hydrocephalus, ultimately presenting in status epilepticus 4 months later secondary to ongoing aneurysm expansion and mass effect.

INTERVENTION

Systemic anticoagulation for acute thrombosis with possible distal arterioarterial embolization from giant P1 aneurysms. Ventriculoperitoneal shunting for hydrocephalus. The patient died within 9 days after admission and 10 years after the initial discovery of aneurysms.

CONCLUSION

Strict control of modifiable risk factors compromising vascular integrity and periodic neuroimaging are warranted in KTS/KTWS patients. KTS/KTWS patients are hypercoagulable, and may be predisposed to aneurysm thrombosis with increased risk for distal arterial microembolization. Stroke-related morbidity secondary to distal arterioarterial aneurysm thrombus embolization and acute aneurysm thrombosis may be decreased with systemic anticoagulation in this patient population. KTS/KTWS patients have significantly higher rates of DVT and PE than the general population, and should be classified in the high-risk category for venous thromboembolism prophylaxis. Both endovascular and open cerebrovascular techniques have been used successfully in KTS/KTWS patients with intracranial aneurysms.

Popliteal arterial aneurysm associated with Klippel-Trénaunay syndrome: Case report and literature review

A 35-year-old woman with Klippel-Trénaunay syndrome developed a popliteal artery aneurysm in the affected extremity. The aneurysm was successfully treated by aneurysmectomy and bypass grafting with autologous saphenous vein. In Klippel-Trénaunay syndrome, angiodysplasia in the venous system is common. However, reports of an arterial aneurysm in a patient with Klippel-Trénaunay syndrome are extremely rare.

Esophageal variceal bleeding caused by hypoplasia of the portal vein in a patient with the Klippel-Trenaunay syndrome

The case of a patient affected by Klippel-Trenaunay syndrome presenting with esophageal variceal bleeding caused by hypoplasia of the vena porta is reported. Hemostasis was achieved by performing a proximal spleno-renal shunt. We discuss the likely association of this mesodermal development abnormality and vascular disorders of the portal vein.