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:
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:
💡 Explanation
**Core Concept**
The patient's presentation suggests chronic venous insufficiency, likely due to previous deep vein thrombosis (DVT) and saphenofemoral junction incompetence, leading to reflux and subsequent ulceration.
**Why the Correct Answer is Right**
The patient's symptoms and phlebography results indicate that the problem lies in the superficial venous system rather than the deep system. The patent deep venous system with free flow of dye suggests that the deep veins are not the source of the obstruction. The incompetent first profunda femoris valve is not directly relevant to the patient's symptoms. Therefore, management should focus on addressing the superficial venous reflux.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not specified, so we cannot evaluate its accuracy.
**Option B:** This option is not specified, so we cannot evaluate its accuracy.
**Option C:** This option is not specified, so we cannot evaluate its accuracy.
**Option D:** This option is not specified, so we cannot evaluate its accuracy.
**Clinical Pearl / High-Yield Fact**
In patients with chronic venous insufficiency, it's essential to identify and treat the underlying cause of superficial venous reflux, which may involve saphenofemoral or saphenopopliteal junction incompetence.
**Correct Answer:** D
✓ Correct Answer: A. 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
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