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

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.