35-Year-Old Female Patient Presents with Purple Stain to Right Lateral Thigh

Ann Kulungowski, M.D.
Taizo Nakano, M.D.
Children's Hospital Colorado, Aurora, CO

  • 35yo F presents to CHCO VAC 11/2018
  • Purple stain to right lateral thigh, RLE overgrowth, blebbing to foot, right buttock, groin
  • Evaluated at multiple facilities throughout lifetime and received multiple diagnoses
  • Has undergone several surgical excisions of bothersome “hemangiomas”
  • DVT at R knee @ 18yo. Coumadin since that time
  • Main complaints:
    • Syncopal unless wearing compression
    • Painful blebbing in groin
  • Diagnosis of Klippel-Trenaunay Syndrome

Treatment Options

  • Patient progressed to syncopal episodes while wearing compression, likely due to large size of marginal vein
  • Concern regarding presence of deep venous system
  • Would marginal vein ablation lead to venous congestion?
  • Referral to Vascular Surgery, considered:
    • Resection of vein
    • Surgical ligation
    • Radio-frequency ablation


  • Patient received venogram and ascending phlebograpy 12/2019, which demonstrated presence of deep venous system
  • Radio-frequency ablation to RLE marginal vein at the knee
  • Patient has demonstrated a drastic improvement in orthostasis
  • No syncopal episodes while wearing compression
  • Able to walk short distances without a compression garment

Patient Case Discussion

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