LEG-LENGTH DISCREPANCY IN LOWER-EXTREMITY VASCULAR MALFORMATIONS: PREVALENCE, RISK FACTORS, AND HEMATOLOGIC COMPLICATIONS FOLLOWING EPIPHYSIODESIS

Abstract

Vascular malformations (VaMs) are congenital anomalies of the vascular system that arise from errors in vascular development. They can be categorized by flow characteristics into low-flow (capillary, venous, or lymphatic) or high-flow (arterio-venous) lesions. A significant concern in lower-extremity VaMs is the development of major leg-length discrepancy (LLD), defined as a ≥2 cm difference between limbs, which can impair gait and joint health. Epiphysiodesis, which arrests growth in the longer limb, is used to address major LLD in children. However, dysplastic vessels and coagulopathies often complicate surgical outcomes in these cases. A. Manuscript 1 Context “Prevalence and Risk Factor Analysis of Leg-Length Discrepancy in Patients with a Capillary Malformation on the Lower Extremities” Capillary malformations (CMs), a subset of low-flow VaMs, frequently lead to progressive LLD. This manuscript quantifies the prevalence of major LLD (≥2 cm) among pediatric patients with lower-extremity CM and identifies risk factors associated with severe discrepancies. This study supports early detection and optimal timing for orthopedic intervention by pinpointing which children are at greatest risk. B. Manuscript 2 Context “Hematologic Complications After Epiphysiodesis for Vascular Malformation–Related Leg-Length Discrepancy” Broadening the scope to all VaM types, this manuscript examines the incidence of venous thromboembolism (VTE) and bleeding events following epiphysiodesis. By analyzing potential perioperative risk factors, it provides insights into how best to safeguard these patients, given their susceptibility to coagulopathic complications and surgical risks.