A child has a large port-wine stain over the left lower limb, prominent varicose veins along the lateral aspect of the thigh, and enlargement of the affected limb compared with the contralateral side. Duplex shows a patent but abnormal deep venous system. Which statement best guides management?

• A Aggressive stripping of all visible varicosities should be undertaken promptly
• B The presence of arteriovenous fistulas confirms the diagnosis
• C Conservative management with graduated compression is preferred, with imaging of the deep system before any venous surgery ✓
• D The limb hypertrophy results from lymphatic hyperplasia and resolves spontaneously

Explanation

This is Klippel-Trenaunay syndrome: the triad of capillary malformation (port-wine stain), varicose veins often including a persistent lateral embryonic (marginal) vein, and soft tissue or bony hypertrophy. Management is mainly conservative with compression garments, sclerotherapy for troublesome veins and limb-length correction if needed. Because the deep veins may be hypoplastic or absent, radical varicose vein surgery risks catastrophic venous outflow loss, so deep system assessment precedes any operation. Arteriovenous fistulas define Parkes-Weber syndrome instead, eliminating option B.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.