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:

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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

Answer

Saphenous venous crossover graft with asastomosis of the end of the right saphenous vein onto the side of competent femoral vein

Answer

Ligated iliofemoral venous thrombectomy with creation of the temporary aeriovenous fistula

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