Crossover saphenous vein bypass (Palma) in phlegmasia caerulea dolens caused by total iliac outflow obstruction.

Phlegmasia caerulea dolens (PCD) is a rare condition that usually tends to occur in association with malignancy, after surgery or trauma, postpartum, in patients with a history of deep vein thrombosis, and in association with a variety of inflammatory conditions. In approximately 10% of patients no underlying cause is found. PCD is characterized by total or near-total occlusion of the venous drainage of the limb. Associated mortality and morbidity rates are high. Contemporary venous thrombectomy, including thrombus removal and arteriovenous fistula (AVF), may improve results. A crossover saphenous vein bypass offers distinct advantages when surgical clearance of the iliac vein is not feasible.