An experience of arthroplasty in Klippel–Trenaunay Syndrome

We wish to discuss the peri-operative problems, difficulties and management in a patient with Klippel–Trenaunay (KT) syndrome undergoing total hip arthroplasty. Although Klippel–Trenaunay is a well-described entity in the realm of haematology, we are unable to find any previous report that could view this syndrome from an arthroplasty point of view from our review of literature and MEDLINE search.     

Hematuria and rectal bleeding in the child with Klippel and Trenaunay syndrome.

We have operated upon 588 patients with Klippel and Trenaunay syndrome. The underlying factor is a congenital malformation of the deep veins: agenesis, atresia or compression by fibrovascular bands of the popliteal, femoral or iliac veins. Of these 588 patients, 6 children between 15 months and 4 years of age had severe rectal bleeding and hematuria. One of these children died from massive bleeding of the rectum with septicemia. Another boy was saved by rectal resection and the last one by subtotal cystectomy. The important venogram shows an absence of the anterior venous pathway (superficial femoral vein) compensated by the abnormal development of 2 venous groups, the vein of the sciatic nerve and large veins along the external aspect of the inferior limb. These 2 venous groups penetrate into the pelvis by the sciatic and gluteal notches and terminate in the internal iliac vein which becomes enormous and has a very high flow. This overflow hinders drainage of the venous collateral from the rectum, the bladder and the vagina. The retro adductor vein, prolongated by the deep femoral vein, represents an anastomosis between the sciatic nerve vein and the common femoral vein. The surgeon must try to widen this pathway.     

Abdominal Collateral Vein as an Unconventional Vascular Access for Hemodialysis in Patient with Central Vein Occlusion

A 65‐year‐old female patient with chronic kidney disease stage 5 and a history of spleen neoplasm with dissemination within peritoneum is presented. During 5 years of hemodialysis therapy, bilateral occlusion of brachiocephalic and iliac vein developed as a consequence of vein catheterization. An attempt to cannulate inferior vena cava was unsuccessful. A cannulation of dilated collateral abdominal veins with dialysis needles allowed to perform several hemodialysis sessions in the patient.     

Correction of Superior Vena Cava Syndrome with Superficial Femoral Vein Juguloatrial Bypass

Several techniques for bypass of the superior vena cava have been described, including spiraled saphenous vein graft, femoral vein graft, and polytetrafluoroethylene graft as conduits. We present two cases of superior vena cava obstruction treated with juguloatrial bypass using harvested superficial femoral vein. We feel that the superficial femoral vein, with its diameter similar to that of the internal jugular vein, provides several advantages compared to other conduits in a juguloatrial bypass.