Management of the Marginal Vein: Current Issues

Abstract

The marginal vein, an abnormal superficial vein of the lateral lower limb, is a remnant of primitive embryonic vessels that have failed to regress. According to the extent, topography and sites of connection with the deep veins, five types have been distinguished by Weber. The marginal vein is valveless and may create venous stasis. Limb-length discrepancy and nevus may coexist. Diagnosis is made by duplex scan examination and phlebography; angio computerized tomography or magnetic resonance effectively demonstrates the vein but yield less haemodynamic data. The best treatment is complete surgical resection of the vein. Resection should be avoided in the rare cases when aplasia of the deep veins exists. A careful skeletonization can be performed if arterio-venous fistulas converge into the vein.

Klippel-Trenaunay syndrome in a patient presenting with venous stasis ulcer

“…In cases of deep vein hypoplasia, marginal vein can be resected since hypoplastic deep veins can spontaneously dilate to almost normal dimensions after marginal vein resection. In cases of deep venous aplasia, the embryonal vein can be the main drainage vein of the leg and resection is unlikely [11,21]. In cases with arteriovenous fistula, venous stasis increases in vessels causing valvular atresia.…”

“…In cases with arteriovenous fistula, venous stasis increases in vessels causing valvular atresia. In these cases, venous skeletonisation may be performed by completely tying up the arterial inflow vessel [21]. Catheter-directed embolization using coils, particulates, or sclerotherapy may be performed in small arteriovenous fistulas [3].…”

Diagnosis and management of the venous malformations of Klippel-Trénaunay syndrome

“…(24) In particular, the persistent sciatic vein should be treated with sclerotherapy or embolization secondary to close proximity of the sciatic nerve. (24,29) Burrows et al reported their series of consecutive sclerotherapy patients with low flow vascular malformations and noted a good or excellent result in up to 90% of patients by clinical survey. However, there was a complication rate of 12% per treatment and a 28% complication rate per patient.…”

Role of sclerotherapy in vascular malformations

“…2) A marginal vein, an abnormal lateral, valveless vein of the lower limb has been treated with sclerosis, mainly with foam. However, because of the existence of huge perforants to the deep system, the technique can be dangerous (22).…”