A 59-year-old woman, had a left femoral venous thrombosis during a pregnancy 30 year ago. Her left greater saphenous vein had been stripped at age 21. She now presents with a large non healing ulceration over the medial left calf, which has continuously progressed despite bed rest, elevation, and use of a suppo stocking. Descending phlebography of the left leg demonstrates a patent deep venous system, with free flow of dye from the groin to foot. The first profunda femoris valve is competent. Appropriate management might include which of the following:
The patient in the question has clinical and radiographic evidence of the postphlebitic syndrome with recanalization of the deep venous system and destruction of the valves. Treatment of this patient includes placement of a competent valve in the deep venous sytem of the thigh. It can be done either by transplantation of a venous valve or transposition of the superficial femoral vein onto the profunda femoris vein below the level of the competent profunda valve. Post phlebitis syndrome can be prevented by the daily use of below knee 30-40mmHg vascular compression stockings. Ref: Harrison's Principles of Internal Medicine, 17th Edition, Page 735, 1651, 1657; Critical Decisions in Thrombosis and Hemostasis By Jeffrey Ginsberg, Page 63; Handbook of Patient Care in Vascular Diseases, Volume 186; Volume 2001 By John W. Hallett, David C. Brewste 4th Edition, Page 272
Division of the superficial femoral vein in the groin and transposition of its distal end onto the profunda femoris vein below the level of the competent profunda valve
Saphenous venous crossover graft with asastomosis of the end of the right saphenous vein onto the side of competent femoral vein
Ligated iliofemoral venous thrombectomy with creation of the temporary aeriovenous fistula
Subfascial ligation of perforating veins in the left calf