Klippel–Trenaunay syndrome is a rare congenital anomaly that is associated with abnormalities in the deep venous system. Operative intervention is often used only when patients fail conservative management for chronic venous insufficiency. We present a case of a deep venous abnormality requiring a saphenous vein crossover Palma procedure, in combination with a left femoral arteriovenous PTFE fistula to manage a non-healing wound from chronic venous insufficiency in a 22-year-old man. This case highlights updates for modern treatment tips for technical and medical management decisions to avoid early graft thrombosis.
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