Patterns of pediatric venous disease

Area of Science:

• Vascular Surgery
• Pediatric Medicine
• Diagnostic Imaging

Background:

• Chronic venous disease (CVD) is well-documented in adults, with established diagnostic and treatment guidelines.
• Limited data exists on pediatric CVD, particularly excluding Klippel-Trénaunay syndrome (KTS) and post-thrombotic syndrome.

Purpose of the Study:

• To define the patterns and characteristics of venous disease in pediatric patients.
• To investigate the diagnostic challenges and potential indicators for pediatric CVD.

Main Methods:

• Retrospective review of venous reflux studies in patients under 18 years old (January 2012 - June 2014).
• Analysis of study indications, patient history, clinical examination findings, and duplex ultrasound results.
• Comparison of venous reflux parameters using one-way analysis of variance.

Main Results:

• Twenty pediatric patients evaluated; common referrals included swelling, varicose veins, and rubor/acrocyanosis.
• 90% of patients demonstrated venous reflux on duplex ultrasound.
• Despite venous reflux, 44% received an alternative diagnosis (e.g., vascular malformation, lymphedema).
• Superficial venous reflux time was significantly increased in patients with primary CVD and KTS compared to those with alternate diagnoses.

Conclusions:

• The differential diagnosis for pediatric lower extremity edema and varicosities is broad, often necessitating adjunctive studies.
• Venous reflux may be present even with an alternative clinical diagnosis in pediatric patients.
• Superficial venous reflux time may assist in diagnosing primary CVD in children, though further research on pediatric venous parameters and natural history is warranted.