Absence of a Deep Vein and the Significance of Drainage from the Superficial Venous System

We submit a case of a 57-year-old man who presented to the Vascular Clinic seeking treatment for worsening varicosities in the left lower extremity. Specifically, these veins were located in the left lateral thigh. He had lost a considerable amount of weight and the varicosities had become more visible and painful. Duplex imaging was performed and revealed non-visualization of the left external iliac and common femoral veins. These findings were confirmed by both computed tomography (CT) imaging and lower extremity venography with fluoroscopy. It was deemed that the great saphenous vein was providing drainage from the limb and, therefore, should not be ablated. Duplex ultrasound was crucial in identifying the abnormal anatomy and planning the subsequent care of the patient. We are reporting this case because of its rarity and to provide awareness.