Marginal vein is not a varicose vein; it is a venous malformation

Abstract

Marginal vein (MV) is one form of venous malformation (VM); MV is not a varicose vein. MV is the outcome of defective development during the later stage of embryogenesis while the vein trunk is formed. It is an embryonic vein tissue remnant remaining on birth following the failure of normal involutional process. MV is the most common VM involved to Klippel-Trenaunay syndrome (KTS); together with the lymphatic malformation, MV is one of two clinically most important congenital vascular malformation components among KTS. MV causes chronic venous insufficiency (CVI) due to a unique condition of avalvulosis (lack of venous valve development) it accompanies with. Besides, it accompanies a high risk of venous thromboembolism (VTE) due to its structural defect with a lack of smooth muscle cell to form the media properly as a truncular VM infrequently causing fatal pulmonary embolism. Therefore, the MV is indicated for the surgical excision whenever feasible not only for the prevention of VTE and CVI but also for abnormal long bone growth known as vascular bone syndrome as well as lymphatic complication precipitated by MV.

A rare case of persistent lateral marginal vein of Servelle in Klippel Trenaunay Syndrome: A successful surgical management

“…So, it carries a higher risk of DVT and PE and this is the most dangerous form of AV malformation. The weakness of smooth muscle of tunica media of the vessel wall and the lack of valve in the vein and reflux is the reason for the high risk of VTE and PE [8] .…”

Significance of lateral marginal vein in Klippel–Trenaunay syndrome

“…Options of surgical treatment include surgical excision, endovenous ablation, embolization of LMV and sclerotherapy (provided the deep veins are patent). In children, surgical treatment to prevent vascular bone syndrome apart from LMV ligation include paediatric orthopaedic interventions such as epiphyseal arrest/plating during the active bone growth period 2–4,6–10 …”

“…The lateral marginal vein (LMV) is a foetal remnant vein that has failed to involute and persists. 1 It is a type of truncal vascular malformation, 2,3 and its presence is characteristic of Klippel-Trenaunay syndrome (KTS). Although the LMV has the appearance of a superficial varicose vein, it is actually a 'truncular-type' venous malformation (VM).…”

“…In children, surgical treatment to prevent vascular bone syndrome apart from LMV ligation include paediatric orthopaedic interventions such as epiphyseal arrest/plating during the active bone growth period. [2][3][4][6][7][8][9][10]…”

Prevalence and inventory of venous anatomical abnormalities in the arms of patients with combined capillary, venous and lymphatic malformations (Klippel–Trénaunay syndrome)

“…Persistent marginal veins have neither media (smooth muscle) nor valves which makes them prone to develop reflux, stasis and intravascular coagulation with an increased risk for thromboembolic events, such as a pulmonary embolism. [12][13][14] Until now, only little is known about the venous anatomy and pathophysiological sequalae in the arms of CVLM-patients.…”