A clinical case of extremely severe major venes displasia in a child

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Abstract

Dysplasia of the great veins (DMV) is known by the names of the authors who described this pathology as Klippel–Trenone syndrome. The clinical picture of the Klippel–Trenone syndrome in the classic description of the authors is characterized by a triad of symptoms: vascular spots, atypical varicose veins, hypertrophy of soft tissues and bones with an increase in the volume and length of the affected limb. It should be emphasized that the severity of these symptoms depends, first of all, on the type of lesion (embryonic or fetal) and the severity of the lesion. Klippel–Trenone syndrome is almost always sporadic, meaning that it develops in people with no family history of the disorder. Research shows that this condition is due to gene mutations that are not inherited. These genetic changes, called somatic mutations, occur randomly in a single cell during the early stages of development before birth. Klippel–Trenone syndrome can be caused by mutations in the PIK3CA gene. This article presents a clinical observation – the course of the disease of a 1-year-old child, with an extremely severe form of dysplasia of the great veins. In the presented clinical observation, attention is drawn to the difficulties of treating this patient against the background of the underlying chronic disease. The treatment of these patients should be carried out on the basis of a multidisciplinary hospital, which includes specialists in vascular surgery, an orthopedist and an intensive care physician. On the example of the described case, diagnostic tactics and surgical treatment are demonstrated. It is obvious that timely surgical and conservative treatment of pathology in children with dysplasia of the great veins improves the quality of life and social adaptation of children.

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About the authors

Mikhail V. Azarov

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: Azarov_89@mail.ru

Postgraduate Student, Department of Surgical Diseases of Childhood

Russian Federation, Saint Petersburg

Dmitry D. Kupatadze

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: ddkupatadze@gmail.com

MD, PhD, Dr. Sci. (Med.), Professor, Head, Department of Surgical Diseases of Childhood

Russian Federation, Saint Petersburg

Viktor V. Nabokov

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: vn59@mail.ru

MD, PhD, Associate Professor, Department of Surgical Diseases of Childhood

Russian Federation, Saint Petersburg

Yuri Y. Makhin

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: mahin@inbox.ru

MD, PhD, Associate Professor, Department of Cardiovascular Surgery

Russian Federation, Saint Petersburg

Levter М. Kolbaia

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: levterletter@mail.ru

Pediatric Surgeon, Laboratory Assistant, Department of Cardiovascular Surgery

Russian Federation, Saint Petersburg

Igor V. Dyug

St. Petersburg State Pediatric Medical University of the Ministry of Healthcare of the Russian Federation

Email: vdyug72@mail.ru

Pediatric Surgeon, Microsurgical Department

Russian Federation, Saint Petersburg

References

  1. Азаров М.В., Купатадзе Д.Д., Набоков В.В., Кочарян С.М. Анатомо-хирургические особенности сосудов нижних конечностей при дисплазии магистральных вен у детей в зависимости от типа и степени тяжести заболевания по данным контрастной флебографии // Педиатр. – 2020. – Т. 11. – № 2. – С. 25–32. [Azarov MV, Kupatadze DD, Nabokov VV, Kocharyan SM. Anatomic and surgical features of lower extremities blood vessels in case of major veins dysplasia in children with various type and severity of the disease according to data of contrast flebography. Pediatrician (St. Petersburg). 2020;11(2): 25-32. (In Russ.)] https://doi.org/10.17816/PED11225-32
  2. Азаров М.В., Купатадзе Д.Д., Набоков В.В. Синдром Клиппеля–Треноне. Этиология, патогенез, диагностика и лечение // Педиатр. – 2018. – Т. 9. – № 2. – С. 78–86. [Azarov MV, Kupatadze DD, Nabokov VV. Klippel–Trenone syndrome. Etiology, pathogenesis, diagnosis and treatment. Pediatrician (St. Petersburg). 2018;9(2):78-86. (In Russ.)] https://doi.org/10.17816/PED9278-86
  3. Исаков Ю.Ф., Тихонов Ю.А., Тихонов Ю.А. Врожденные пороки периферических сосудов у детей. – М.: Медицина, 1974. – 116 с. [Isakov YuF, Tikhonov YuA, Tikhonov YuA. Vrozhdennye poroki perifericheskikh sosudov u detei. Moscow: Meditsina, 1974. 116 p. (In Russ.)]
  4. Купатадзе Д.Д. Ангиомикрохирургия в педиатрии. – СПб, 2016. [Kupatadze DD. Angiomikrokhirurgiya v pediatrii. Saint Petersburg, 2016. (In Russ.)]
  5. Купатадзе Д.Д., Азаров М.В., Набоков В.В. Клиника, диагностика и лечение детей с дисплазией магистральных вен // Педиатр. – 2017. – Т. 8. – № 3. – С. 101–106. [Kupatadze DD, Azarov MV, Nabokov VV. Clinic, diagnosis and treatment of children with dysplasia of the main veins. Pediatrician (St. Petersburg). 2017;8(3):101-106. (In Russ.)] https://doi.org/10.17816/PED83101-106
  6. Макаров Л.М., Иванов Д.О., Поздняков А.В., и др. Компьютерная визуализация результатов биомедицинских исследований // Визуализация в медицине. – 2020. – Т. 2. – № 3. – С. 3–7. [Makarov LM, Ivanov DO, Pozdnyakov AV, et al. Computer visualization of results biomedical research article title. Visualization in medicine. 2020;2(3):3-7. (In Russ.)]
  7. 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(3):482-493. https://doi.org/10.1016/j.jvsv.2019.12.003
  8. Klippel M, Trenaunay P. Noevus variqueux osteohypertrophique. J des Praticiens. 1900. Vol. 14. P. 65 (In French).
  9. Klippel M., Trenaunay P. Du Noevus variqueux osteohypertrophique. Arch Gen Med. 1900;185:641-672 (In French).
  10. Lee BB, Bergan J, Gloviczki P, et al. Diagnosis and treatment of venous malformations. Consensus Document of the International Union of Phlebology (IUP) “International angiology”. 2009;28(6):434-451.
  11. Lim Y, Fereydooni A, Brahmandam A, et al. Mechanochemical and surgical ablation of an anomalous upper extremity marginal vein in CLOVES syndrome identifies PIK3CA as the culprit gene mutation. J Vasc Surg Cases Innov Tech. 2020;6(3):438-442. https://doi.org/10.1016/j.jvscit.2020.05.013
  12. Luks VL, Kamitaki N, Vivero MP, et al. Lymphatic and other vascular malformative / overgrowth disorders are caused by somatic mutations in PIK3CA. J Pediatr. 2015;166(8):1048-1054. https://doi.org/10.1016/j.jpeds.2014.12.069
  13. Maari C, Frieden IJ. Klippel–Trénaunay syndrome: the importance of “geographic stains” in identifying lymphatic disease and risk of complications. J Am Acad Dermatol. 2004;51(3):391-398. https://doi.org/10.1016/j.jaad.2003.12.017
  14. Mulliken JB, Burrows PE, Fishman SJ, editors. Mulliken & Young’s Vascular Anomalies Hemangiomas and Malformations, ed. 2. Oxford: University Press, 2013. 606-609 p. https://doi.org/10.1093/med/9780195145052.001.0001
  15. Nassiri N, Cirillo-Penn NC, Thomas J. Evaluation and management of congenital peripheral arteriovenous malformations. J Vasc Surg. 2015;62(6):1667-1676. https://doi.org/10.1016/j.jvs.2015.08.052
  16. Nassiri N, Thomas J, Cirillo-Penn NC. Evaluation and management of peripheral venous and lymphatic malformations. J Vasc Surg Venous Lymphat Disord. 2016;4(2):257-265. https://doi.org/10.1016/j.jvsv.2015.09.001
  17. Ochoco GETD, Enriquez CAG, Urgel RJL, Catibog JS. Multimodality imaging approach in a patient with Klippel-Trenaunay syndrome. BMJ Case Rep. 2019;12(8): e228257. https://doi.org/10.1136/bcr-2018-228257
  18. Oduber CE, Young-Afat DA, Van der Wal AC, et al. The persistent embryonic vein in Klippel–Trenaunay syndrome. Vasc Med. 2013;18(4):185-191. https://doi.org/10.1177/1358863X13498463
  19. Uller W, Fishman SJ, Alomari AI. Overgrowth syndromes with complex vascular anomalies. Semin Pediatr Surg. 2014;23(4):208-215. https://doi.org/10.1053/j.sempedsurg.2014.06.013
  20. Vahidnezhad H, Youssefian L, Uitto J, et al. Klippel–Trenaunay syndrome belongs to the PIK3CA-related overgrowth spectrum (PROS). Exp Derm. 2016;25(1):17-16. https://doi.org/10.1111/exd.12826
  21. Wassef M, Blei F, Adams D, et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics. 2015;136(1):203-214. https://doi.org/10.1542/peds.2014-3673
  22. Wetzel-Strong SE, Detter MR, Marchuk DA. The pathobiology of vascular malformations: insights from human and model organism genetics. J Pathol. 2017;241(2):281-293. https://doi.org/10.1002/path.4844.

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1. Patient K.V., 1 years old: dysplasia of the main veins, embryonic type, extremely severe: а&– appearance, b&– ascending phlebography, c&– embryonic vein in the subcutaneous tissue of the popliteal region (operation stage)

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3. Fig. 2. Patient K.V., 2 years old: dysplasia of the main veins, embryonic type, extremely severe grade: а, b&– appearance after surgery; c&– appearance with a prosthesis

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Copyright (c) 2021 Azarov M.V., Kupatadze D.D., Nabokov V.V., Makhin Y.Y., Kolbaia L.М., Dyug I.V.

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