We report a 53-year-old female patient presenting with a refractory venous leg ulcer and unremarkable findings in the doppler Ultrasound venous mapping of the leg veins. Further comprehensive diagnostics demonstrated an underlying May-Thurner syndrome. After resolution of the primary mechanical obstruction, rapid wound healing in the following 3 weeks was documented. Iliac vein compression syndrome, commonly known as May-Thurner syndrome, is a distinguishable anatomical variant that results from an external compression over the left iliac vein exerted by the overriding adjacent right common iliac artery. It is mostly seen among young, healthy female patients and can easily be under-diagnosed. Lower extremities duplex ultrasonography remains the gold standard in diagnosing venous insufficiency, but it should not solely depend on it. Instead, clinicians should consider other possibilities, assessing the patency within the truncal veins, which in turn might contribute to the venous insufficiency along the lower limbs. An active early diagnostic approach can prevent significant overall morbidity and help patients to ease back into their daily-life activities. Therefore, it is recommended that all patients with suspected venous insufficiency and normal lower limbs duplex findings should undergo further evaluation of the truncal venous system pattern. May-Thurner syndrome, along with other causes of iliac veins compression, should be considered in the differential diagnosis in unclear persistent cases of unilateral venous symptoms.

Dear Editors, A 62-year-old woman presented in our wound-healing department with an ulcer in the dorsum of her right foot, which already existed for 5 months. According to the patient anamnesis, painful reddish brown lesions occurred 8 months ago. A skin sample of these lesions was taken for further histopathological evaluation. As a result of this procedure, a non-healing ulcer of the dorsum of the foot developed. The patient underwent specific therapies, including diverse externa, wound dressings and systemic glucocorticoids, which have not led to any improvement. The patient denied any pre-existing diseases or injuries and does not take any regular medications.At the patient's first presentation in our clinic, the size of the ulcer was approximately 1⋅8 cm 2 . Clinically, it was covered with fibrin and very painful (8 of 10 points on the visual analogue scale). There were hypo-and hyperpigmentation in the ulcer's surroundings (Figure 1). According to that, deposits of haemosiderin were described in the histological sample. On further examination we found an angioma of 4 × 3 cm on the foot's sole, which existed since birth. Moreover, the right leg was approximately 1 cm longer than the left one.We performed a duplex sonography and plethysmography, which did not provide any evidence of venous insufficiency of the lower leg region. Although there were bruits, which could only be interrupted by the Valsalva manoeuvre, we accordingly suspected the existence of arteriovenous (AV)-shunts. This diagnosis was confirmed by the duplex sonography. A subsequently performed angiography showed multiple AV-shunts at the medial aspect of the dorsum of the foot (Figure 2). A magnetic resonance imaging (MRI) revealed a hypertrophic arteria