Surgical treatment of venous malformations

in Klippel-Trénaunay syndrome
Audra A. Noel, MD,a Peter Gloviczki, MD,a Kenneth J. Cherry, Jr, MD,a
Thom W. Rooke, MD,b Anthony W. Stanson, MD,c and David J. Driscoll,
MD,d Rochester, Minn

Purpose: Klippel-Trénaunay syndrome (KTS) is a complex congenital anomaly, charac-

terized by varicosities and venous malformations (VMs) of one or more limbs, port-wine
stains, and soft tissue and bone hypertrophy. Venous drainage is frequently abnormal
because of embryonic veins, agenesis, hypoplasia, valvular incompetence, or aneurysms
of deep veins. We previously reported on the surgical management of KTS. In this arti-
cle, we update our experience.
Methods: Twenty patients with KTS underwent surgical treatment for VMs between July
1, 1987, and January 1, 2000. This group represented 6.9% of 290 patients with KTS
who were seen at our institution during this 12.5-year study period. Surgical indica-
tions, venous anatomy (determined with duplex scan, contrast phlebography, magnetic
resonance imaging or magnetic resonance phlebography), operative procedures, and
complications were reviewed, and outcomes were recorded.
Results: Twelve male and eight female patients (mean age, 23.4 years; range, 7.7-40.6
years) underwent 30 vascular surgical procedures in 21 lower limbs. All 20 patients
(100%) had varicose veins or VMs, 13 (65%) had port-wine stains, and 18 (90%) had
limb hypertrophy. Pain was the most common complaint, which was present in 16
patients (80%), followed by swelling in 15 (75%), bleeding in 8 (40%), and superficial
thrombophlebitis and cellulitis in 3 (15%). Imaging confirmed patent deep veins in 18
patients, hypoplastic femoral vein in 1, and entrapped popliteal veins bilaterally in 1.
Four patients (20%) had large persistent sciatic veins (PSVs). The CEAP clinical classi-
fication was C-3 for 17 patients (85%), C-4 for 1 patient (5%), and C-6 for 2 patients
(10%). Stripping of large lateral veins, avulsion, and excision of varicosities or VMs were
performed on all limbs. Three patients required staged resections. The release of
entrapped popliteal veins was performed in both limbs of one patient; another under-
went a popliteal-saphenous bypass graft. One patient underwent excision of a PSV.
Open and endoscopic perforator vein ligation was performed in one patient each. Two
patients (12%) had hematomas that required evacuation. No patients had caval filter
placement; none had postoperative deep venous thrombosis or pulmonary embolus. The
mean follow-up was 63.6 months (range, 0-138 months). All patients reported initial
improvement, but some varicosities recurred in 10 patients (50%), an ulcer did not heal
in one, and a new ulcer developed in one, 8 years after surgery. Three patients under-
went reoperation for recurrent varicosities. Follow-up CEAP scores were C-2 in 10
patients (50%), C-3 in 6 patients (30%), C-4 and C-5 in 1 patient each (5%), and C-6 in
2 patients (10%). Clinical scores improved from 4.3 ± 2.2 to 3.1 ± 2.3. (P = .03).
Conclusions: The management of patients with KTS continues to be primarily nonoper-
ative, but those patients with patent deep veins can be considered for excision of symp-
tomatic varicose veins and VMs. Although the recurrence rate is high, clinical improve-
ment is significant, and reoperations can be performed if needed. Occasionally, deep vein
reconstruction, excision of PSVs, or subfascial endoscopic perforator surgery is indicat-
ed. Because KTS is rare, patients should receive multidisciplinary care in qualified vas-
cular centers. (J Vasc Surg 2000;32:840-7.)

From the Division of Vascular Surgerya and the Departments of
Vascular Medicine,b Vascular and Interventional Radiology,c
and Pediatric and Adolescent Medicine,d Mayo Clinic and
Mayo Foundation.
Competition of interest: nil.
Reprint requests: Peter Gloviczki, MD, Mayo Clinic, 200 First Street
SW, Rochester MN 55905 (e-mail: gloviczki.peter@mayo.edu).
Copyright © 2000 by The Society for Vascular Surgery and The
American Association for Vascular Surgery, a Chapter of the
International Society for Cardiovascular Surgery.
0741-5214/2000/$12.00 + 0 24/6/110343
doi:10.1067/mva.2000.110343

840
JOURNAL OF VASCULAR SURGERY
Volume 32, Number 5 Noel et al 841

Klippel-Trénaunay syndrome (KTS) is a complex

congenital malformation that may affect the lower
or upper extremities or, less commonly, involve the
trunk, head, or neck. The three main components of
KTS are varicosities and venous malformations
(VMs), capillary malformations (port-wine stains),
and hypertrophy of the soft tissue and bone.
Frequently, venous drainage is abnormal because of
persistent embryonic veins, agenesis, hypoplasia,
valvular incompetence, or aneurysms of deep veins.
The management of chronic venous insufficiency in
patients with KTS requires precise preoperative doc-
umentation of the venous anatomy and function. In
1991, we reported on our initial experience with
surgical treatment for chronic venous insufficiency
in patients with KTS.1 In this article, we update our
experience. The data of six previously reported
patients have been included in this report.
A
METHODS
Between July 1, 1987, and January 1, 2000, 290
patients with KTS were evaluated at the Mayo
Clinic. Of this group, 20 patients (6.9%) underwent
surgical treatment for symptomatic varicosities and
vascular malformations or for swelling and pain asso-
ciated with chronic venous insufficiency. Each
patient’s clinical history and results of a physical
examination, including the presence of soft tissue
and bony hypertrophy, capillary malformations
(port-wine stains), and VMs, were recorded. Venous
anatomy was documented with contrast phlebogra-
phy, magnetic resonance imaging (MRI), magnetic
resonance phlebography (MRP), and duplex scans.
Twenty phlebograms were available; all were rere-
viewed by two authors (A. W. S. and A. N.). Surgical
procedures and complications were recorded.
Follow-up evaluation was obtained through a clinic B
visit or a patient questionnaire. The CEAP and clin-
ical severity scale, based on pain, edema, venous Fig 1. A, 19-year-old man with a large incompetent later-
claudication, skin changes, and ulceration, as recom- al embryonic vein extending from the ankle to saphe-
mended by the Consensus document of the Joint nofemoral junction. B, Same patient is allowed to stand
Vascular Societies,2 was recorded. A paired 2-tailed for 5 minutes, and the veins are marked with ink pen
t test was used to compare preoperative and postop- before vein stripping and avulsion of varicosities.
erative clinical scores, with significance defined as a
P value less than .05.
2), and 18 (90%) had limb hypertrophy. One
RESULTS woman had two pigmented lesions over her affected
Clinical characteristics. Twenty patients, 12 knee without the typical capillary malformation
male and eight female (mean age, 23.4 years; range, characteristics. Eleven patients (55%) had all three
7.7–40.6 years) underwent 30 vascular surgical pro- sequelae of KTS. Clinical findings were noted at
cedures in 21 limbs. All 20 patients (100%) had vari- birth in 16 patients (80%), with a mean age 6.8
cose veins, 11 (55%) had large lateral embryonic months (range, birth to 6 years). No patients had a
veins (Fig 1, A), 13 (65%) had port-wine stains (Fig family history of KTS. Three patients had concomi-
 JOURNAL OF VASCULAR SURGERY
842 Noel et al November 2000

Table I. Clinical presentation of VMs in 20

patients with KTS
Symptom No. of patients (%)

Pain 16 (80)
Edema 15 (75)
Bleeding 8 (40)
Superficial thrombophlebitis 3 (15)
Cellulitis 3 (15)

Table II. Preoperative contrast phlebography find-

ings in 20 patients with KTS
Anatomic feature No. of patients (%)

Large lateral embryonic vein 20 (100)

Medial varicosities 13 (65)
Band-like narrowing of popliteal vein 9 (45)
Incompetent perforating veins 6 (30)
Hypoplastic SFV 5 (25)
Popliteal vein aneurysm 4 (20)
Fig 2. Port-wine stain (capillary malformation) on affect- SFV ectasia 4 (20)
ed extremity of patient with KTS. Note large lateral PSV 4 (20)
embryonic vein of the thigh (arrow). Entrapped popliteal veins 1 (5)

in 16 patients (80%), both lower extremities in 2

Fig 3. Ascending phlebogram in 36-year-old woman
demonstrating a PSV (arrow) and a markedly enlarged
greater saphenous vein (double arrows).
tant malformations including mitral valve prolapse,
spinal stenosis, and pectus carinatum.
Pain was the most common complaint at the
time of presentation to our institution, occurring in
16 patients (80%). One lower extremity was affected
(10%), both lower extremities and one upper
extremity in 1 (5%), and a crossed upper and lower
extremity in 1 (5%). No patients were asymptomatic.
Other presenting symptoms are summarized in
Table I. CEAP classification scores were C-3 in 17
patients (85%), C-4 in 1 (5%), and C-6 in 2 (10%).
The mean clinical severity scale before surgical treat-
ment was 4.3 ± 2.2.
Diagnostic imaging. All patients underwent
contrast phlebography, 19 (95%) underwent MRI
examinations, and 13 (65%) underwent venous
duplex scan. Table II summarizes the contrast phle-
bography findings (Figs 3 and 4). All patients had
evidence of lateral embryonic veins. An abnormal
contour of the popliteal or superficial femoral vein
(SFV) was noted in 19 patients (95%), with the most
common deep venous abnormality of band-like nar-
rowing of the popliteal vein demonstrated in nine
patients (45%). Four patients (20%) had persistent
sciatic veins (PSVs), based on contrast phlebogram
and MRI. MRI and MRP confirmed extension of
VMs into the subfascial plane or muscle involvement
in 12 (63%) of 19 patients (Fig 5). Four patients
(21%) had pelvic VMs and one (5%) had labial vari-
cosities. Venous duplex scan documented deep
venous incompetence in nine (70%) of 13 patients.
Although, avalvulia accounts for venous incompe-
JOURNAL OF VASCULAR SURGERY
Volume 32, Number 5 Noel et al 843

tence in a subgroup of patients with KTS, we could

not determine the type of valvular abnormalities in
the nine patients with venous incompetence.
Surgical treatment and morbidity. Preoperative
vein marking with an ink pen was performed in all
patients (Fig 1, B). Twenty-nine procedures (97%)
were performed with patients under general anesthe-
sia, whereas one procedure (3%) was performed with
the patient under epidural anesthesia. Avulsion and
excision of varicosities or VMs were performed on all
limbs, after confirmation of a patent deep system,
with concomitant stripping of the incompetent saphe-
nous vein in three patients (15%) or the lateral embry-
onic vein in eight patients (40%). The lesser saphe-
nous vein was stripped in three patients (15%).
Tourniquet was used to limit blood loss in 13 (43%)
of 30 procedures. The greater saphenous vein was
stripped from the saphenofemoral junction to the
ankle with a flexible stripper. Varicosities and VMs
were excised or avulsed through stab incisions or
small incisions, with care taken during avulsion of lat-
eral varicosities to stay in a superficial plane therefore
avoiding the peroneal nerve. If possible, a stripper was
used to remove large lateral embryonic veins. The lat-
eral embryonic vein was stripped while the tourniquet
was inflated in six patients (30%). Because of the large
size of this vein, multiple skin incisions were made
along the vein, and the vein was tied to the stripper
with 2-0 silk. The release of entrapped bilateral
popliteal veins was performed in one patient, before
resection of large superficial veins in both limbs. One
patient, reported previously, had excision of a large
PSV and excision of symptomatic labial varicosities.
One patient, also included in our previous report,
underwent deep vein reconstruction with the saphe-
nous vein.1 In this patient, the saphenous vein from
the contralateral unaffected limb was interposed from
the popliteal vein to the proximal segment of the
greater saphenous vein. The patient with the popliteal-
to-saphenous vein reconstruction had a patent graft
with ultrasound scan examination 102 months post-
operatively, although small venous ulcers recurred,
probably because of deep and incompetent perforat-
ing veins. Incompetent perforators were ligated in
one patient with an open technique early in the series
and in one patient with subfascial endoscopic perfora-
tor surgery (SEPS). Blood was transfused to one
patient (2 units) postoperatively after popliteal vein
release, despite tourniquet control. A second patient
received blood (1 unit) during resection of a VM
without an occluding tourniquet. Two patients (10%)
received perioperative subcutaneous heparin injec-
tions for deep venous thrombosis (DVT) prophylaxis,
Fig 4. Ascending phlebogram in 19-year-old man con-
firms large lateral embryonic vein with multiple varicosities
(arrow) and a phlebectasia (double arrows) of the popliteal
vein with band-like narrowing.
and one patient (5%) who had a deep vein recon-
struction was given heparin intravenously and con-
verted to permanent warfarin therapy.
All patients had postoperative compression of
the affected extremity with an elastic wrap and were
given 30– to 40–mm Hg stockings to wear starting
10 to 14 days after surgery. The intervention was
complicated by a hematoma that required drainage
in two patients (12%). No patients had DVT, pul-
monary embolism, wound infection, or peroneal
nerve injury. No patients reported postoperative
neuralgia. Caval interruption was not performed
preoperatively in any of the patients.
The mean follow-up was 63.6 months (median,
56 months; range, 1-138 months). All patients
reported initial improvement. At the time of the last
follow-up, 18 patients (90%) were free of pain and
free of swelling with the use of compressive garments,
with good compliance reported in all 18 patients. The
remaining two patients (10%) relayed the same symp-
toms as before surgery. Varicosities recurred in 10
patients (50%). Three patients (15%) underwent
repeat excision for recurrence. Three patients (15%)
required multiple resections of the same VM, with
delays of 8 months, 8 years, and 9 years. The ulcer did
not heal in one patient, another patient had new
ulcers 8 years after surgery, and one had chronic cel-
lulitis associated with chylous drainage from lymphat-
ic vesicles of the lower extremity. Follow-up CEAP
 JOURNAL OF VASCULAR SURGERY
844 Noel et al November 2000

Fig 5. MRI of the leg of 7-year-old boy with extensive VMs of left leg involving the soleus and
gastrocnemius muscles. Also note large lateral vein (arrow).

Table III. Comparison of preoperative and postop- The etiology of KTS is still under investigation.
erative CEAP scores in 20 patients with KTS According to the definition by Szilagyi et al,6 KTS is
a mixed vascular malformation without macrofistu-
Preoperative Postoperative
CEAP score no. of patients (%) no. of patients (%) lous arteriovenous communication. Suggested causes
include a developmental mesodermal abnormality,
C1 0 (0) 0 (0) which results in an increase in the size and number of
C2 0 (0) 10 (50)
C3 17 (85) 6 (30)
veins and subsequently causes increased bone and
C4 1 (5) 1 (5) soft tissue growth.9 This hypothesis is supported by
C5 0 (0) 1 (5) the measurement of increased blood flow in affected
C6 2 (10) 2 (10)
KTS limbs, especially those extremities with capillary
malformations, despite the absence of detectable
arteriovenous fistulae.9 The hypothesized mesoder-
scores were C-2 in 10 patients (50%), C-3 in 6 (30%), mal abnormality may be regulated by angiogenesis
C-4 and C-5 in 1 each (5%), and C-6 in 2 (10%) and vasculogenesis factors such as vascular endothe-
(Table III). Clinical severity scores improved from 4.3 lial growth factor (VEGF).10 Disruption of the deli-
± 2.2 to 3.1 ± 2.3. (P = .03). cate balance of VEGF-mediated vascular remodeling
may result in abnormal vascular development and
DISCUSSION subsequent limb hypertrophy. However, the effect of
In 1900, Klippel and Trénaunay3 described a hemodynamic factors on limb hypertrophy is not
syndrome encompassing extremity soft tissue and confirmed and may be less significant than previous-
bony hypertrophy, varicosity and hemangioma. ly thought. Our opinion remains that soft tissue and
Since that time, the definition of KTS has been bony hypertrophy are not direct consequences of
refined. The “hemangiomas” in patients with KTS venous stasis in these patients.
are vascular malformations. Frequent anomalies of Most cases are sporadic, and familial trends have
the deep venous system, such as agenesis, hypopla- not been confirmed, although some cases within the
sia, atresia, valvular incompetence, or external com- same family have been reported. In a recent series of
pression of the veins by fibrous bands accompany 114 patients with KTS, two families with familial
the classic clinical presentation of KTS.1,4,5 True KTS were documented, as well as the occurrence of
hemangiomas, which are neoplasms with proliferat- familiar hemihypertrophy and naevi inflammei in
ing endothelium, rarely occur in KTS, and the VMs first-degree relatives in other pedigrees.11 In a report
or capillary malformations associated with KTS con- of 14 patients from Spain, paternal and maternal age
tain static endothelium.6 An important distinction of and the number of pregnancies were related to the
KTS is the absence of significant arteriovenous prevalence of KTS, which suggested a variably
shunting. High-flow high-shunt arteriovenous fistu- expressed autosomal dominant inheritance.12 How-
lae are characteristics of Parkes-Weber syndrome, a ever, because of the small sample size, larger series
malformation that has significantly more hemody- must be reviewed to document genetic associations.
namic complications.7,8 In most cases, the patient’s family notes the clin-
JOURNAL OF VASCULAR SURGERY
Volume 32, Number 5
ical presentation of KTS at birth or in the first few
years of life.13 In a large series of 252 patients with
KTS reported from our institution, 98% had capil-
lary malformations, 72% had varicosities or VMs,
and 67% had limb hypertrophy. Of these 252
patients, 63% had all three features of KTS, which is
comparable to the 55% of patients with all three
sequelae in our small surgical group. Although they
are not noted in our current series, syndactyly,
macrodactyly, polydactyly, and hip dysplasia have
been reported in up to 29% of patients with KTS.1,13
Clinical symptoms are related to the extent and loca-
tion of the hypertrophy and VMs, which may vary
from mild varicosities to massively enlarged limbs or
truncal involvement.14,15 In our series, all patients
considered for surgical treatment for VMs and vari-
cosities were symptomatic, with pain and edema the
most frequent complaints. Asymptomatic patients
were not offered vascular surgical intervention and
were managed expectantly because of the high fre-
quency of recurrence of varicosities (50%). KTS may
also be associated with lymphedema or lymphatic
malformations, as evidenced in one of our patients
with chylous reflux.4,16
Before surgical intervention, contrast phlebogra-
phy and MRI or MRP should document venous
anatomy. The primary goal is to confirm patency of
the deep venous system before excision of superficial
veins. In addition, descending phlebography, with
duplex scanning, is used to assess deep venous
incompetence in the deep, superficial, and perfora-
tor system in the extremity and the pelvis.1 All
patients considered for surgical treatment should
have contrast phlebography for operative planning.
Despite narrowing or hypoplasia that is evident on
phlebography, satisfactory collateralization is often
seen on ascending phlebography. Therefore, judg-
ment and experience are necessary to determine the
need for venous reconstruction or excision of con-
stricting bands. Duplex scan examination is impor-
tant, particularly in mapping incompetent perforat-
ing veins if SEPS is planned on the basis of patient
symptoms.17,18 MRI and MRP provide three-
dimensional imaging of VMs and are useful in defin-
ing the hypertrophy of the bony and soft tissue and
the extent and depth of VMs within the subcuta-
neous or subfascial space. MRI may provide the only
documentation of PSV, which is confirmed with
phlebography in only 60% to 70% of patients with
PSV.19 Evidence of intramuscular VMs on MRI will
guide surgical therapy, because such lesions are dif-
ficult to treat surgically and nearly always recur.
Scanograms (long bone films) are usually performed
Noel et al 845
serially in all patients with KTS to document leg
length discrepancy and bony hypertrophy.
Surgical intervention is guided by symptoms.
Although bleeding may be an indication to operate,
most patients present with symptoms of persistent
venous hypertension. Pain, aching, swelling, and
ulceration can develop as a result of severe valvular
incompetence in persistent superficial embryonic
veins, in perforating veins, or in abnormal deep
veins. Although rare, deep venous reconstruction or
release of restricting fibrous bands is indicated in a
small group of patients, including two (10%) of our
20 patients.20,21 One of our patients had symptoms
of venous hypertension after stripping of the greater
saphenous vein elsewhere. Hypoplastic deep veins
were subsequently diagnosed, and the patient
underwent venous bypass grafting. The results for
these patients are good, but difficult to assess
because of the small volume of cases. Deep vein
reconstruction is indicated in symptomatic patients
with unilateral hypoplastic or absent veins with
venous outflow obstruction due to inadequate or
surgically removed collateral drainage. SFV transpo-
sition has been described by Taheri et al21 in a 17-
year-old patient with KTS with absent SFV valves
and symptomatic Grade IV reflux. The release of
extrinsic compressive bands surrounding deep veins
in KTS has been best documented by Servelle. In his
series of 768 cases, he found popliteal compression
in 71%, with a perivenous sheath in 15%, which was
based primarily on operative observations rather
than preoperative phlebography.4 On the basis of
this large series, Servelle recommended resection of
the compressive sheaths along the length of the vein
to restore the vein to nearly normal caliber.
The most common venous surgical treatments
are stripping of veins, including lateral embryonic
veins, and avulsion or excision of varicosities and
VMs. Before surgery, venous anatomy must be con-
firmed with contrast phlebography, MRI, and MRP.
The use of intraoperative tourniquet, inflated to 300
mm Hg to reduce blood loss in patients with KTS
with high venous pressure, is helpful. Although 50%
of patients with KTS will have recurrent varicosities
and it is nearly impossible to remove all varicosities
because of the extent of disease, the overall clinical
improvement after surgical treatment is good. This
improvement is documented by a significant reduc-
tion in the clinical severity score in our patients. In
addition, most of our patients reported subjective
improvement in symptoms, which is consistent with
other series of surgically treated patients with
KTS.22 Mildly symptomatic patients, however,

846 Noel et al
should still be managed with compressive garments
unless symptoms progress. Postoperative sclerother-
apy with 0.75% to 1% polidocanol or sodium
tetradecyl sulfate (Sotradecol) has been reported to
be a useful adjunct to surgery in patients with
intractable symptoms.23 To date, we have not used
sclerotherapy in our practice. In our series, perioper-
ative complications were fortunately rare. Despite
the reported proclivity of patients with KTS for
DVT,24 DVT or pulmonary embolism did not occur
in patients in our series, perhaps because of the use
of compressive garments and early mobilization.
In a subset of patients with incompetent perfo-
rating veins, the adjunctive use of SEPS can be con-
sidered after careful documentation of the venous
anatomy. Early in our series, open ligation of incom-
petent perforating veins through a limited incision
was performed at the time of VM excision in one
patient. Open perforator vein ligation procedures
have been replaced at our institution with SEPS,
which is completed under tourniquet control to
provide a bloodless endoscopic field. Again, preop-
erative imaging, especially duplex scan documenta-
tion and marking of incompetent perforators, is an
important adjunct to successful SEPS.25
Although most patients with KTS are managed
nonoperatively, the venous disease associated with
KTS can be treated successfully with surgery when
patients are selected carefully and venous anatomy is
well defined with preoperative contrast phlebogra-
phy and MRI. Patent deep veins must be present to
excise symptomatic varicose veins and VMs.
Although excision of varicosities is often incomplete
and VMs may recur in 50% of patients, overall clini-
cal improvement is noted in most patients, and reex-
cision may be performed as indicated. Occasionally,
deep vein reconstruction, excision of a PSV, or SEPS
is indicated. Because KTS is rare and the patients’
problems often complex, patients should receive
multidisciplinary care in qualified vascular centers.
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Submitted Feb 17, 2000; accepted Jun 5, 2000.

LIFELINE FOUNDATION
E. J. Wylie Traveling Fellowship
Guidelines: The primary purpose of the E. J. Wylie Traveling Fellowship is to provide the recipient with the
opportunity to visit a number of excellent vascular surgery centers in the United States and abroad. Though brief,
these visits stimulate academic inspiration, promote international exchange, and foster development of fraternal
fellowship in vascular surgery. The achievement of these objectives will enhance the development of the fellow’s
career in vascular surgery.
This award is not intended to support specific research interests but rather to assist the fellow in a unique oppor-
tunity for travel and professional exchange within established vascular centers in this country and abroad.
Eligibility for Selection:
1. Be under age 40 at the time of the award
2. Have completed a postgraduate vascular training program or have considerable experience in vascular
surgery supplemental to surgical training
3. Be committed to an academic career in vascular surgery and have obtained an academic appointment in a
medical school or freestanding clinic devoted to excellence in medical education
4. Have a demonstrated record of success in pursuing clinical or basic science research sufficient to ensure aca-
demic excellence in his or her pursuit of a career in vascular surgery
Selection will be made without regard to the candidate’s geographic location.
Requirements for Consideration:
A candidate submitting documentation for consideration for selection must furnish an up-to-date curriculum
vitae; a list of publications, research projects, and current research support; and a list of the centers that he or she
wants to visit. Three letters of recommendation are required, including one from the division head and another
from the chairman of the department of surgery of the institution in which the candidate holds a faculty appoint-
ment. A 500-word essay describing the objectives of the candidate’s travel plans and linking these to his or her
career goals must be appended.
Report to Committee:
A report covering your experience should be prepared and forwarded to the Chairman of the Research &
Education Committee within 3 months of completion of your fellowship travel. This report should be five to
eight double-spaced typewritten pages and should summarize your activities during the fellowship. Although fac-
tual statements of activities should be included, you are encouraged to place these within an overall context of
their impact on your education and maturation. The format of the report and its content should be suitable for
consideration by the Committee for publication in the Journal of Vascular Surgery.
Financial Support:
The generosity of W. L. Gore & Associates, Inc, has allowed the establishment of this fellowship. Their gra-
ciousness ensures the noncommercial nature of the award and its continuation in years to come. The E. J. Wylie
Traveling Fellowship of the Lifeline Foundation will pay up to $12,000 for expenses of travel, research, and cler-
ical help. The fellowship monies may not be used for other purposes.
Application:
No application forms are required. A letter demonstrating interest in applying for the E. J. Wylie Traveling
Fellowship or nominating a candidate may be sent to the Chairman of the Research and Education Committee.
Details of the application should include the materials requested above. The deadline for receiving applications
is January 15. Decisions regarding the award will be mailed to the applicants by mid April.
A letter of nomination or intent should be directed to:
Chairman
Research and Education Committee
Lifeline Foundation
13 Elm Street
Manchester, MA 01944