Left Common Femoral to Right Common Iliac Venous Bypass Through a Retroperitoneal Exposure

Abstract

The endovascular recanalization of the iliocaval system has replaced venous surgical reconstructions as the primary treatment option in severe post-thrombotic syndrome (PTS). We herein present a 51-year-old female with previous deep venous thrombosis, complicated with PTS with a large and complex circumferential calf ulcer measuring 25 cm of length in the left lower extremity. Venogram revealed a complete and extensive occlusion in the left iliofemoral system. A surgical bypass from the left common femoral vein to the right common iliac vein was performed. Patient recovered well and after 12 months postoperation her large wound is healing favorably with a clean and well granulated bed. Iliofemoral venous bypass is a feasible treatment for non-healing ulcer of lower extremity.

Keywords: Post-thrombotic syndrome; Retroperitoneal exposure; Venous bypass.

Fig. 1

Ascending venogram shows chronic left iliofemoral vein complete obstruction, draining through pelvic collateral.

Fig. 2

(A) Preoperative circumferential calf ulcer with fibrin and necrosis. (B, C) Ulcer after surgery and wound care at 5 and 10 months of follow-up respectively with re-epithelialized and granulation tissue.

Fig. 3

Ultrasound images of iliofemoral bypass. (A) Patent iliofemoral bypass (white arrows). (B) Doppler ultrasound of patent distal anastomosis in iliac vein (white arrow).