6-Year-Old Female Patient Presents with Right Lateral Leg Staining

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

  • 6yo F who presented in first year of life with right lateral leg staining
  • Imaging at 2 yr of age demonstrated marginal vein

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

Treatment Strategies

  • Supportive, not curative
  • In this patient, early identification of marginal vein made for easy interventional treatment via embolization and sclerotherapy
  • Management options for bothersome lymphatic component
  • Sirolimus laser therapy
  • Surgical debulking
  • Several rounds of percutaneous sclerotherapy for painful, bleeding vesicles
  • Topical sirolimus trial – no relief
  • Oral sirolimus trial – unable due to social factors
  • Decision to move forward with staged surgical debulking


  • Referral for wound care
  • Predictable wound healing difficulties due to underlying disease
  • Continued discussion regarding further resection
  • Continue with compression
  • Monitor limb length discrepancy until puberty

Patient Case Discussion

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