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Genetics of Klippel-Trenaunay-Weber Syndrome

  • Author: Ravi Sunderkrishnan, MD; Chief Editor: Maria Descartes, MD  more...
 
Updated: Jan 13, 2015
 

Background

Klippel-Trenaunay syndrome (KTS) is defined by the presence of a combined vascular malformation of the capillaries, veins, and lymphatics; congenital venous abnormalities; and limb hypertrophy. See the image below.

Klippel-Trenaunay syndrome in a young person. Note Klippel-Trenaunay syndrome in a young person. Note the port-wine stain extending to the buttocks. These lesions can be associated with venous malformations involving the rectum and bladder.

Isolated reports of cases of limb hypertrophy were published in the 19th century, but the combination of a congenital vascular nevus of an extremity, venous varices on the affected side, and limb hypertrophy was not recognized as a consistent and unique syndrome until a 1900 article by Klippel and Trenaunay. A few years later, Frederick Parkes Weber published a report of similar patients in whom enlarged arteries and veins, rather than just venous abnormalities, were present. Patients with limb hypertrophy, cutaneous capillary malformations, and venous and arterial malformations sometimes receive a diagnosis of Klippel-Trenaunay-Weber syndrome.

Parkes Weber syndrome (PWS) is closely associated with and similar to Klippel-Trenaunay syndrome, except that an arteriovenous malformation (AVM) occurs in association with a cutaneous capillary malformation and skeletal or soft tissue hypertrophy.

Sturge-Weber syndrome is defined by the presence of a meningeal angioma, cutaneous capillary malformation of the face, and glaucoma; this is often accompanied by hemiparesis and hemiatrophy contralateral to the meningeal angioma.[1]

Although each of these syndromes is distinct, overlap does rarely occur. This article focuses on Klippel-Trenaunay syndrome and Parkes Weber syndrome.

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Pathophysiology

Klippel-Trenaunay syndrome is characterized by a combined type of vascular malformation of the skin, abnormalities of the venous and lymphatic systems, and limb enlargement. Lymphatic vesicles appear on the surface of the capillary malformation; the lymph may also ooze at times. In addition, the abnormal venous system may produce protrusions of veins on the surface of the skin, called venous flares. Varicose veins appear in early childhood, and lateral venous anomalies are seen in 80% of cases.

Limb hypertrophy is due to the presence of vascular, venous, and lymphatic abnormalities but also to the hypertrophy of soft tissue and bone. The hypertrophy is often asymmetrical and often involves the digits. Ninety-five percent of cases involve the lower extremity.

Because the vascular abnormalities in Klippel-Trenaunay syndrome are not associated with arterial malformations, flow through the malformations is slow. The combination of low-flow vascular abnormalities and lymphatic involvement makes the skin lesions appear bluish or purplish.

In contrast, Parkes Weber syndrome is characterized by the presence of arteriovenous fistulas, and flow through the cutaneous malformations is fast, giving the lesions a pink color. Cardiac hypertrophy or high-output congestive heart failure occurs.

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Epidemiology

Frequency

United States

Klippel-Trenaunay syndrome and Parkes Weber syndrome are rare sporadic conditions with no racial or geographic predisposition. Parkes Weber syndrome is much less common than Klippel-Trenaunay syndrome.

Mortality/Morbidity

See the list below:

  • Klippel-Trenaunay syndrome and Parkes Weber syndrome have a mortality rate of 1%.
  • All patients have significant morbidity.
    • Hypertrophy of the extremities or digits can be extreme, requiring amputation.
    • Lymphatic involvement with lymph vesicles may lead to poor wound healing.
    • Although superficial vein abnormalities are common, the deep vein can also be involved with thrombosis.
    • Pulmonary embolism may occur in 10% of patients, particularly after surgery.[2]
    • Pain may also be a feature of Klippel-Trenaunay syndrome.
    • One half of patients can be treated solely using medical means.

Race

See the list below:

  • No racial predilection is noted.

Sex

See the list below:

  • No sex predilection is observed.

Age

See the list below:

  • The cutaneous vascular malformation is apparent at birth.
  • The venous varicosities and limb hypertrophy may not be apparent initially.
  • The average age of presentation of children to a medical center is 4 years.
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Contributor Information and Disclosures
Author

Ravi Sunderkrishnan, MD Fellow in Nephrology, Thomas Jefferson University Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Margaret M McGovern, MD, PhD Professor and Chair of Pediatrics, Stony Brook University School of Medicine

Margaret M McGovern, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics

Disclosure: Nothing to disclose.

Chief Editor

Maria Descartes, MD Professor, Department of Human Genetics and Department of Pediatrics, University of Alabama at Birmingham School of Medicine

Maria Descartes, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American Medical Association, American Society of Human Genetics, Society for Inherited Metabolic Disorders, International Skeletal Dysplasia Society, Southeastern Regional Genetics Group

Disclosure: Nothing to disclose.

Additional Contributors

Michael Fasullo, PhD Senior Scientist, Ordway Research Institute; Associate Professor, State University of New York at Albany; Adjunct Associate Professor, Center for Immunology and Microbial Disease, Albany Medical College

Michael Fasullo, PhD is a member of the following medical societies: Radiation Research Society, American Society for Biochemistry and Molecular Biology, Genetics Society of America, Environmental Mutagenesis and Genomics Society

Disclosure: Nothing to disclose.

Acknowledgements

Bruce Buehler, MD Professor, Department of Pediatrics and Genetics, Director RSA, University of Nebraska Medical Center

Bruce Buehler, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Association on Mental Retardation, American College of Medical Genetics, American College of Physician Executives, American Medical Association, and Nebraska Medical Association

Disclosure: Nothing to disclose.

James H Tonsgard, MD Associate Professor, Department of Pediatrics and Neurology, University of Chicago; Consulting Staff, Department of Neurology, Little Company of Mary Hospital; Consulting Staff, Department of Neurology, Lakeshore Hospital

Disclosure: Nothing to disclose.

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Klippel-Trenaunay syndrome in a young person. Note the port-wine stain extending to the buttocks. These lesions can be associated with venous malformations involving the rectum and bladder.
 
 
 
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