1.

Kohinur, 60yrs woman,has a left femoral venous thrombosis during a pregnancy 30 year ago.The left greater saphenous vein had been stripped at age 21.She now presents with a large non healing ulceration over the medical left calf,which has continuously progressed despite bedrest,elevation,and use of a support 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.Which of the following is appropriate management?

A. Ligated illiofemoral venous thrombectomy with creation of the temporary arteriovenous fistula
B. Subfascial ligation of perforating veins in the left calf
C. 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
D. Saphenous venous crossover graft with asastomosis of the end of the right saphenous vein onto the side of competent femoral vein
Answer» D. Saphenous venous crossover graft with asastomosis of the end of the right saphenous vein onto the side of competent femoral vein


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