Sapheno-femoral crossover venous bypass in a case of deep vein thrombosis: an uncommonly done procedure for a very common disease

Abstract

Vascular bypass procedures using saphenous vein graft are commonly done in cases of peripheral vascular disease, however in cases of venous disease the use of vascular bypass is limited , even though reports in literature show good results with resolution of symptoms in majority of patients. A review of the results of deep vein reconstruction for obstructive disease reveals the clear ability to perform these procedures with the minimum of risk, and the results in the successful cases demonstrate the improvement that follows correction of the physiologic abnormalities of obstruction [1]. Management of venous obstruction seems to be a bit neglected as far as surgical management is concerned with anticoagulants playing the major role. The procedures used in management of unilateral iliofemoral thrombosis are Palma’s procedure (cross-over femoro-femoral venous bypass using saphenous vein from contralateral thigh), use of prosthetic conduits and endovascular interventions. Deep Vein Thrombosis (DVT) is a very common disease with acute presentation of sudden onset edema, difficulty in walking and severe pain in the leg. Initial management is usually with anticoagulants and thrombolysis, with very few patients undergoing embolectomy. Medical management in the acute phase mostly leads to partial recannalization. After resolution of symptoms partially, the chronic phase sets in where patients continue to have edema, develop pigmentation, varicose veins and decreased work performance. Virchow’s triad of stasis, hypercoagulability and injury to vessel wall are important in the pathogenesis and management of the disease. Cross-over femoral venous bypass is suitable for persistent isolated unilateral iliac or common femoral vein occlusions in young and middle aged patients with severe chronic deep venous insufficiency unresponsive to conservative measures [2]. This case is reported to highlight the benefit and good results of vascular bypass in venous obstructions where facility for endovascular procedures is not available.