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

Area of Science:

• Vascular Surgery
• Venous Thromboembolism
• Wound Healing

Background:

• Post-thrombotic syndrome (PTS) following deep venous thrombosis (DVT) can lead to severe complications like non-healing ulcers.
• Endovascular recanalization is the standard treatment for PTS, but complex cases may require alternative solutions.
• Large, circumferential lower extremity ulcers indicate significant venous compromise.

Observation:

• A 51-year-old female presented with a 25 cm left calf ulcer due to severe PTS from extensive left iliofemoral venous occlusion.
• Venographic imaging confirmed complete occlusion of the left iliofemoral system.
• A surgical iliofemoral venous bypass was performed, connecting the left common femoral vein to the right common iliac vein.

Findings:

• The patient experienced a positive recovery following the venous bypass surgery.
• After 12 months, the large calf ulcer showed significant improvement, with a clean, granulated wound bed.
• Iliofemoral venous bypass demonstrated feasibility in treating a non-healing lower extremity ulcer secondary to severe PTS.

Implications:

• Surgical venous bypass is a valuable treatment option for complex PTS cases unresponsive to endovascular therapy.
• This approach can facilitate healing of severe, chronic venous ulcers, improving patient quality of life.
• Further research into the long-term outcomes of iliofemoral venous bypass for PTS-related ulcers is warranted.