Skip to main content
Annals of Surgery logoLink to Annals of Surgery
. 1983 Mar;197(3):353–362. doi: 10.1097/00000658-198303000-00017

Surgical implications of Klippel-Trenaunay syndrome.

P Gloviczki, L H Hollier, R L Telander, B Kaufman, A J Bianco, G B Stickler
PMCID: PMC1352741  PMID: 6299216

Abstract

Between January 1956 and July 1981, 40 patients with Klippel-Trenaunay syndrome were seen at the Mayo Clinic. Twenty male and 20 female patients presented with the classic triad of soft tissue and bony hypertrophy of the extremity, hemangioma, and varicosity without evidence of functional arteriovenous fistulae. The lower extremity was involved in 38 patients (95%), the upper extremity in six patients (15%). In four of these cases (10%), both the upper and lower extremities were affected. The disease was unilateral in 34 patients (85%), bilateral in five cases (12.5%), and crossed-bilateral in one case (2.5%). Surgery was done in 13 patients (32.5%), nine of whom were operated on at the Mayo Clinic and four of whom had had previous surgery elsewhere. Excision and stripping of varices were performed in three patients; of these three, a deterioration of symptoms was observed in one, but the procedure was beneficial in the other two. Partial varicectomy was performed in four cases, while resection of the angioma was attempted in eight cases, with good results in three cases of small angiomas. Femoral and tibial epiphysiodesis stopped the overgrowth and produced an excellent result in one case. In four cases of epiphysiodesis at the foot level and two cases of derotational tibial osteotomy, moderate improvement was achieved. The indication for vascular or orthopedic surgery should be carefully considered in each patient who has this syndrome. One patient (2.5%) died of a severe form of the disease, but the relatively benign course is documented by the 21 patients (52.5%) who are free of complaints without any treatment or with elastic support only.

Full text

PDF
356

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BLOUNT W. P., CLARKE G. R. Control of bone growth by epiphyseal stapling; a preliminary report. J Bone Joint Surg Am. 1949 Jul;31A(3):464–478. [PubMed] [Google Scholar]
  2. Bollinger A., Vogt B., Lüthy E., Hegglin R. Flow measurements in patients with multiple arteriovenous fistulas of the extremities. Helv Med Acta. 1966 Apr;33(1):76–87. [PubMed] [Google Scholar]
  3. Bourde C. Classification des syndromes de Klippel-Trénaunay et de Parkes-Weber d'après les données angiographiques. Ann Radiol (Paris) 1974 Mar;17(2):153–160. [PubMed] [Google Scholar]
  4. CORMIER J. M., BOUCHARD F., BINET J. P., MATHEY J. [Congenital arteriovenous fistulas of an extremity. (Critique of paraclinical examinations)]. Presse Med. 1962 Oct 24;70:2115–2118. [PubMed] [Google Scholar]
  5. COURSLEY G., IVINS J. C., BARKER N. W. Congenital arteriovenous fistulas in the extremities; an analysis of sixty-nine cases. Angiology. 1956 Jun;7(3):201–217. doi: 10.1177/000331975600700301. [DOI] [PubMed] [Google Scholar]
  6. GREEN W. T. Equalization of leg lengths. Surg Gynecol Obstet. 1950 Jan;90(1):119–122. [PubMed] [Google Scholar]
  7. Gourie-Devi M., Prakash B. Vertebral and epidural hemangioma with paraplegia in Klippel-Trenaunay-Weber syndrome. Case report. J Neurosurg. 1978 May;48(5):814–817. doi: 10.3171/jns.1978.48.5.0814. [DOI] [PubMed] [Google Scholar]
  8. HUTCHISON W. J., BURDEAUX B. D., Jr The influence of stasis on bone growth. Surg Gynecol Obstet. 1954 Oct;99(4):413–420. [PubMed] [Google Scholar]
  9. JANES J. M., MUSGROVE J. E. Effect of arteriovenous fistula on growth of bone; preliminary report. Proc Staff Meet Mayo Clin. 1949 Aug 3;24(16):405–408. [PubMed] [Google Scholar]
  10. LINDENAUER S. M. THE KLIPPEL-TRENAUNAY SYNDROME: VARICOSITY, HYPERTROPHY AND HEMANGIOMA WITH NO ARTERIOVENOUS FISTULA. Ann Surg. 1965 Aug;162:303–314. doi: 10.1097/00000658-196508000-00023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Leu H. J. Klinik des Syndroms von Klippel-Trénaunay-Weber. Zentralbl Phlebol. 1970 Nov;9(4):218–225. [PubMed] [Google Scholar]
  12. MALAN E., PUGLIONISI A. CONGENITAL ANGIODYSPLASIAS OF THE EXTREMITIES. I. GENERALITIES AND CLASSIFICATION; VENOUS DYSPLASIAS. J Cardiovasc Surg (Torino) 1964 Mar-Apr;5:87–130. [PubMed] [Google Scholar]
  13. MARTORELL F., MONSERRAT J. Atresic iliac vein and Klippel-Trenaunay syndrome. Angiology. 1962 Jun;13:265–267. doi: 10.1177/000331976201300605. [DOI] [PubMed] [Google Scholar]
  14. MYERS T. T., JANES J. M. Comprehensive surgical management of cavernous hemangioma of the lower extremity with special reference to stripping. Surgery. 1955 Feb;37(2):184–197. [PubMed] [Google Scholar]
  15. Macpherson R. I., Letts R. M. Skeletal diseases associated with angiomatosis. J Can Assoc Radiol. 1978 Jun;29(2):90–100. [PubMed] [Google Scholar]
  16. May R., Nissl R. Beitrag zur Klassifizierung der "gemischten kongenitalen Angiodysplasien". Fortschr Geb Rontgenstr Nuklearmed. 1970 Aug;113(2):170–189. [PubMed] [Google Scholar]
  17. McCullough C. J., Kenwright J. The prognosis in congenital lower limb hypertrophy. Acta Orthop Scand. 1979 Jun;50(3):307–313. doi: 10.3109/17453677908989772. [DOI] [PubMed] [Google Scholar]
  18. PACK G. T., MILLER T. R. Hemangiomas; classification, diagnosis and treatment. Angiology. 1950 Oct;1(5):405–426. doi: 10.1177/000331975000100504. [DOI] [PubMed] [Google Scholar]
  19. Partsch H., Lofferer O., Mostbeck A. Shuntvolumsbestimmung bei gemischten Angiodysplasien der Extremitäten. Zur Differenzierung des Klippel-Trenaunay-Syndromas vom F.P. Weber-Syndrom. Wien Klin Wochenschr. 1973 Aug 3;85(31):544–547. [PubMed] [Google Scholar]
  20. Partsch H., Lofferer O., Mostbeck A. Zur Diagnostik von arteriovenösen Fisteln bei Angiodysplasien der Extremitäten (Kriterien für eine Operationsindikation) Vasa. 1975;4(3):288–295. [PubMed] [Google Scholar]
  21. Phillips G. N., Gordon D. H., Martin E. C., Haller J. O., Casarella W. The Klippel-Trenaunay syndrome: clinical and radiological aspects. Radiology. 1978 Aug;128(2):429–434. doi: 10.1148/128.2.429. [DOI] [PubMed] [Google Scholar]
  22. SERVELLE M., ALBEAUX-FERNET M., LABORDE S., CHABOT J., ROUGEULLE J. Lésions des vaisseaux lymphatiques dans les malformations congéitales des veines profondes. Presse Med. 1957 Mar 20;65(23):531–534. [PubMed] [Google Scholar]
  23. Schaal P. G., Blundell P. E. The Klippel-Trenaunay syndrome. A case report and review. J Cardiovasc Surg (Torino) 1976 May-Jun;17(3):230–233. [PubMed] [Google Scholar]
  24. Servelle M., Babillot J. Les malformations des veines profondes dans le syndrome de Klippel et Trenaunay. Phlebologie. 1980 Jan-Mar;33(1):31–36. [PubMed] [Google Scholar]
  25. Servelle M., Bastin R., Loygue J., Montagnani A., Bacour F., Soulie J., Andrieux J. B. Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome. Ann Surg. 1976 Apr;183(4):418–428. doi: 10.1097/00000658-197604000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Vollmar J., Vogt K. Angiodysplasie und Skeletsystem. Chirurg. 1976 Apr;47(4):205–213. [PubMed] [Google Scholar]
  27. Vollmar J., Voss E. U. Chirurgie der kongenitalen Angiodysplasien. Langenbecks Arch Chir. 1978 Nov;347:255–259. doi: 10.1007/BF01579338. [DOI] [PubMed] [Google Scholar]
  28. Vollmar J., Voss E. Vena marginalis lateralis persistens - die vergessene Vene der Angiologen. Vasa. 1979;8(3):192–202. [PubMed] [Google Scholar]
  29. Vollmar J. Zur Geschichte und Terminologie der Syndrome nach F. P. Weber und Klippel-Trénaunay. Vasa. 1974;3(3):231–241. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES