Persistence of the embryonic lateral marginal vein: report of two cases

Abstract

Purpose: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases.Methods: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed.Results: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence.Conclusions: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

The persistent embryonic vein in Klippel–Trenaunay syndrome

“…Both veins may occur in KTS [5][6][7][8][9][10][11][12] and may be associated with both normal and anomalous deep venous systems. 3,[9][10][11][12][16][17][18][19] An international interdisciplinary anatomical consensus was reached in 2002 and specifically named the 'sciatic vein', defining it as a deep vein of the posterior thigh perforators, lying along the midline of the posterior thigh and running along the sciatic nerve. [20][21][22][23] The sciatic vein should be regarded as 'the main trunk of the primordial deep venous system'.…”

“…A lateral marginal vein is also called 'vein of Servelle', 'Klippel-Trenaunay vein' and 'lateral venous anomaly', while a PSV is also referred to as a 'lateral venous anomaly'. 3,[5][6][7][8][9][10][11][12]18,[24][25][26][27][28][29][30][31][32] This variation in names hampers comparisons between studies.…”

“…This provides a clear, uniform classification based on international anatomical consensus, [20][21][22][23] and information on whether surgical intervention is possible as deep venous insufficiency precludes this. [9][10][11]17,19,26,33 …”

“…11,17 When patency is confirmed, phlebography is advised prior to surgical intervention. [9][10][11]19 However, both imaging techniques have drawbacks. For instance, ultrasound studies have shown that a previously diagnosed hypoplastic deep venous system became competent and open after compression of a LMV just above and just below the knee.…”

“…It has been previously reported that the embryonic dorsal or sciatic vein system normally regresses around weeks 10 to 12 of fetal life, but evidence from human studies is lacking. 10,19,30 A study conducted on the limbs of rabbit embryos in 1906 by Lewis showed that the sciatic vein is the second leg vein generated during embryogenesis (the first being the lateral/posterior fibular (peroneal) vein) and consists of the anterior tibial and primitive fibular veins. In rabbits, the proximal section of the sciatic vein regresses after the femoral anastomosis near the knee has formed.…”