Endovascular iliac vein recanalization after Palma procedure for treatment of recalcitrant venous ulcer.

A 57-year-old man with post-thrombotic syndrome presented to the vascular clinic with multiple recurrent nonhealing ulcerations, swelling, and hyperpigmentation of the right lower extremity 30 years after a Palma procedure. On venography, a right to left femoral-femoral Palma bypass graft was noted to be patent, with occlusion of the iliac vein. Endovascular stenting of the right iliac veins led to complete resolution of symptoms and ulcer healing. The bypass and the stents remain patent 4 years after the procedure.