LAGB is a safe and efficient bariatric procedure. With experience, the complication rate drops to a very low level. Close follow-up can further increase its efficacy.

We aim here to highlight the importance of diagnosing and treating promptly the rarely thought of diagnosis of plantar vein thrombosis. We hereby report two cases with no known thrombotic risk factors. Less than 20 cases are reported in the literature. Detection of this unusual site of involvement of the deep venous system can be easily made by ultrasound examination if searched for. Plantar vein thrombosis is a rarely evoked pathology. Knowledge of its occurrence could further improve its diagnosis especially that it could reveal an unknown neoplasia or coagulation abnormality.

Tunnel-transposition and lipectomy are efficient techniques to allow easy needling of deeply situated upper-arm basilic vein, and cephalic vein in obese patients, respectively.

Vessel or graft repair, PTA for distal stenoses and local debridement followed by a Limberg skin flap for tissue defects prevented further bleeding and maintained vascular access patency in 25/40 (62%) patients.

Despite many pitfalls for the surgeon, BrVT offers promising long-term patency.