A healthy 57 year old woman presented with CEAP class C5 bilateral chronic venous insufficiency. The patient denied previous deep vein thrombosis or perinatal hospitalisation. Duplex ultrasound revealed bilateral great saphenous vein (GSV) pre-terminal valve incompetence, absence of the right common (CFV), deep femoral (DFV) and femoral veins, and presence of a suprapubic collateral varicose vein. The left GSV trunk was competent whereas the right was not. Computed tomography venography showed a patent but hypoplastic right external iliac vein with absent right CFV. The venous circulation of the right limb was guaranteed by two physiological bypasses: a superficial one through the suprapubic vein (Panel A, arrow) which drained into the left saphenofemoral junction, and a retropubic one (Panels A and B, arrowhead) which drained into the left CFV. Surgical or endovascular treatment was not indicated and elastic stockings were prescribed.