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Modified Palma Bypass Using the Deep Femoral Vein as the Inflow for Severe Post-Thrombotic Syndrome: A Case Report

Year: 2025

Type: article

Abstract: Iliofemoral post-thrombotic syndrome may lead to severe venous claudication and leg ulceration. Surgical bypass remains a valuable alternative when endovascular recanalization is unsuccessful. We present a modified Palma procedure using the deep femoral vein (DFV) as an inflow, given the unavailability of the common femoral vein. A 40-year-old man with chronic left leg pain, edema, and ulceration had complete occlusion of the left iliofemoral axis with failed percutaneous attempts. A crossover bypass was performed using the contralateral great saphenous vein, anastomosed end-to-side to the DFV. Postoperatively, pain and edema resolved, and the ulcer healed within 90 days. Duplex ultrasonography at 2 months confirmed graft patency with preserved phasic flow. This technical modification offers a feasible alternative for complex post-thrombotic cases when conventional inflow sites are compromised and may expand surgical options for deep venous reconstruction.

Source: Vascular Specialist International

DOI: 10.5758/vsi.250056

Authors: Juan José Ramírez-Mosquera, Mariana Pinzón-Pinto, Leonardo Randial, Martín Contreras, Luis Felipe Cabrera-Vargas

Institutions: Pontificia Universidad Javeriana, Fundación Santa Fe de Bogotá

Language: English

Topic: Venous Thromboembolism Diagnosis and Management

Subfield: Internal Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4416604096

FWCI:

Cites: 17

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