Diagnosis and Surgical Aspects of Congenital Venous Angiodysplasia in the Extremities

Abstract

Objective: An evaluation of the treatment of patients with venous angiodysplasia and severe chronic insufficiency. Design: The clinical series of patients with venous angiodysplasia of Klippel-Trenaunay (K-T) and Servelle-Martorell (S-M) type. Setting: Primary care teaching hospital. Patients: Eighty-three patients with angiodysplasia type K-T characterized by the triad of local giantism, varicose veins and naevus flammeus. Malformations of the deep venous system were present in 96%. The predominant vascular lesion in patients with the S-M syndrome ( n=34) was a haemangiomatosis, involving both the skeleton and soft tissues, causing growth retardation in the affected extremity. A malformation of the deep venous system could be seen in all patients. Main outcome measures: Healing of skin ulcers and varicose bleeding of the lower extremities. Interventions: Conservative treatments included external compression bandages or stockings. In 14 patients, surgical extirpation of superficial veins was used. Results: All the ulcers were treated successfully, and no haemorrhage reoccurred. Haemodynamic studies showed an improvement of the venous reflux disease in 86% of patients. Conclusion: Venous angiodysplasia of the lower extremity is nearly always associated with malformation of the deep venous system. Surgery is indicated for the elimination of a pathological short circuit flow in atypical drainage veins of the affected leg, especially when skin lesions are present. For any type of surgery, a careful preoperative angiographic and haemodynamic evaluation is mandatory.