Crossover Femorofemoral Vein Bypass in a Case with Chronic Iliac Outflow Obstruction due to Pelvic Trauma

Abstract

A 34-year-old male was admitted to our hospital for the treatment of chronic venous insufficiency of the left lower extremity due to iliac venous outflow obstruction. He had previously undergone emergent surgery because of the blunt colon injury and pelvic fracture due to downfall accident. After that, he suffered severe pain and swelling of the left leg during exercise which could not be controlled by conservative therapies including elastic compression. Preoperative ultra sonography of the left leg showed the occlusion of the femoral vein at the level 1 cm above the saphenofemoral junction. Crossover saphenous vein bypass (Palma procedure) was performed. Calf pump was activated just after the completion of venous anastomosis to avoid early graft occlusion. His symptom was relieved. Although postoperative venography showed the Palma graft was diffusely thin, it was enlarged and became good venous outflow 5 months after the surgery.