- 6yo F who presented in first year of life with right lateral leg staining
- Imaging at 2 yr of age demonstrated marginal vein
Treatment Options
- Patient progressed to syncopal episodes while wearing compression, likely due to large size of marginal vein
- Concern regarding presence of deep venous system
- Would marginal vein ablation lead to venous congestion?
- Referral to Vascular Surgery, considered:
- Resection of vein
- Surgical ligation
- Radio-frequency ablation
Outcome
- Patient received venogram and ascending phlebograpy 12/2019, which demonstrated presence of deep venous system
- Radio-frequency ablation to RLE marginal vein at the knee
- Patient has demonstrated a drastic improvement in orthostasis
- No syncopal episodes while wearing compression
- Able to walk short distances without a compression garment
Treatment Strategies
- Supportive, not curative
- In this patient, early identification of marginal vein made for easy interventional treatment via embolization and sclerotherapy
- Management options for bothersome lymphatic component
- Sirolimus laser therapy
- Surgical debulking
- Several rounds of percutaneous sclerotherapy for painful, bleeding vesicles
- Topical sirolimus trial – no relief
- Oral sirolimus trial – unable due to social factors
- Decision to move forward with staged surgical debulking
Takeaways
- Referral for wound care
- Predictable wound healing difficulties due to underlying disease
- Continued discussion regarding further resection
- Continue with compression
- Monitor limb length discrepancy until puberty
Patient Case Discussion
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