{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:04:00Z","timestamp":1789913040535,"version":"4.0.1"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Phlebology"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Klippel-Tr\u00e9naunay syndrome (KTS) is a rare congenital vascular malformation disorder involving complex venous, lymphatic, and soft-tissue abnormalities. Doppler ultrasound (DUS) is widely used for vascular assessment, but the relationship between ultrasound-derived features and venous clinical severity in KTS remains insufficiently defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter study included 58 patients with clinically diagnosed KTS involving 63 affected lower extremities between January 2020 and December 2022. We evaluated whether selected DUS-derived features were associated with venous clinical severity assessed using CEAP class and VCSS. Associations were analyzed using Kendall\u2019s tau-b correlation and exploratory generalized additive models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Deep venous anomalies were identified in 25 of 63 affected extremities (39.7%). The LMV was detected in 60 extremities (95.2%), with a mean diameter of 5.23\u00a0mm. Posture-dependent venous caliber or visualization changes were observed in nine extremities (14.3%). VCSS increased across CEAP classes (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). LMV diameter showed a moderate positive correlation with VCSS (tau = 0.338,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; .001). In the exploratory GAM, LMV diameter showed a possible nonlinear association with VCSS, with higher scores observed around and above an approximately 5-mm reference point (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .049). Morphologic lymphatic malformation was also associated with higher VCSS after adjustment for model covariates (beta = 2.23,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = .020).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DUS-derived features, particularly LMV diameter and morphologic lymphatic malformation, were associated with venous clinical severity in lower-limb KTS. Supine-standing DUS additionally demonstrated posture-dependent venous caliber or visualization changes in a subset of extremities. These findings support standardized DUS as a useful imaging approach for phenotypic assessment and follow-up in KTS, while the exploratory LMV diameter reference point requires prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02683555261490370","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:37:22Z","timestamp":1789778242000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel Doppler ultrasound approach for phenotypic assessment and follow-up of Klippel-Tr\u00e9naunay syndrome: A retrospective multicenter study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8921-7544","authenticated-orcid":false,"given":"Dan","family":"Li","sequence":"first","affiliation":[{"name":"Shantou University Medical College"},{"name":"Liwan Central Hospital of Guangzhou"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Yang","sequence":"additional","affiliation":[{"name":"Liwan Central Hospital of Guangzhou"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiana","family":"Li","sequence":"additional","affiliation":[{"name":"Shantou University Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Tan","sequence":"additional","affiliation":[{"name":"Guangzhou Medical University (National Children\u2019s Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyin","family":"Liu","sequence":"additional","affiliation":[{"name":"Guangzhou Medical University (National Children\u2019s Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiejun","family":"Xia","sequence":"additional","affiliation":[{"name":"Guangzhou Medical University (National Children\u2019s Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Xia","sequence":"additional","affiliation":[{"name":"The Affiliated People\u2019s Hospital of Fujian University of Traditional Chinese Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5342-6019","authenticated-orcid":false,"given":"Jianzhong","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangzhou Medical University (National Children\u2019s Medical Center)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghui","family":"Su","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Shantou University Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_9_2_2","doi-asserted-by":"publisher","DOI":"10.1258\/026835507782655209"},{"key":"e_1_3_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tvir.2019.100634"},{"key":"e_1_3_9_4_2","first-page":"1421","article-title":"Klippel-Trenaunay Syndrome, segmental\/focal overgrowth malformations: a review","volume":"10","author":"Pavone P","year":"2023","unstructured":"Pavone P, Marino L, Cacciaguerra G, et al. Klippel-Trenaunay Syndrome, segmental\/focal overgrowth malformations: a review. Child Basel Switz 2023; 10: 1421. https:\/\/doi.org\/10.3390\/children10081421","journal-title":"Child Basel Switz"},{"key":"e_1_3_9_5_2","unstructured":"International Society for the Study of Vascular Anomalies. ISSVA classification of vascular anomalies \u00a92018. https:\/\/www.issva.org\/classification. Accessed 28 June 2026."},{"key":"e_1_3_9_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2016.10.084"},{"key":"e_1_3_9_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/a-0998-4300"},{"key":"e_1_3_9_8_2","first-page":"157","article-title":"A step-by-step sonographic approach to vascular anomalies in the pediatric population: a pictorial essay","volume":"31","author":"Mittal A","year":"2021","unstructured":"Mittal A, Anand R, Gauba R, et al. A step-by-step sonographic approach to vascular anomalies in the pediatric population: a pictorial essay. 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