Amine Bahnini, Claude Franceschi, : Treatment of the Klippel-

� The Klippel-Trenaunay Syndrome KTS is a clinical syndrome of lower limbs disease made of superficial varicose veins, deep veins hypo or aplasia, cutaneous angioma or angiokeratome and lower limb excessive length. Actually, it is just a peculiar combination of truncular venous congenital malformations where the deep venous block ( hypoplasia) is responsible for the limb elongation and the varicose veins ( marginal and/or others) overloaded and dilated for their role of vicarious by-pass (open vicarious shunt). The non vicarious varicose veins may be dilated not only because of an excessive congenital compliance but also because they are overloaded by closed circuit flow (closed shunt). � The strategy of KTS treatment is based on the Duplex assessment and its consequent hemodynamic mapping. It consists in mini-invasive surgery that disconnects the closed shunts just below the escape points in order to suppress the overloading flow. This leads to a progressive collapse of its varicose vein of which the preservation prevents the varicose recurrence due to “necessary” superficial drainage, particularly from the cutaneous angioma. On the other hand, the vicarious varicose veins are untouched because their disconnection or ablation could lead to a dramatic drainage impairment of the limb. In truncular malformations free of deep venous block (frequently marginal vein), only superficial varicose veins due to closed shunts are disconnected like in KTS.