A Case of Cross-Pubic Venous Bypass (Palma procedure) for the Treatment of Left Iliac Vein Occlusion and Ipsilateral Ilio-Femoral Arteriovenous Fistulae

Abstract

We report a case of chronic left iliofemoral vein occlusion with ipsilateral arteriovenous fistulae (AVF) in the leg. The patient was a 58-year-old woman who had a history of left hemi-palsy due to cerebral infarction. The patient underwent implantation of an infra vena cava (IVC) filter in the left common iliac vein as she suffered from deep venous thrombosis and subsequent pulmonary embolism. However, the filter caused occlusion of the left iliac veins, after which atriovenous fistulae developed in the left pelvis. Left leg and the skin in these areas swelled notably. Palma bypass was performed using a saphenous vein graft and the venous pressure in the left leg subsequently decreased from 66 to 33 mmHg. The edema in the left leg consequently subsided and the patient was discharged without any complications. Palma bypass is the main treatment for iliofemoral chronic occlusion worldwide, however, few studies in Japan have reported on it. The technique was very effective for the treatment of hemi-iliofemoral vein occlusion and ipsilateral atriovenous fistulae.