Aorto-ilicofemoral arterial reconstructive surgery. With special reference to profunda revascularization

A series of 177 patients undergoing 190 reconstructions for aorto-ilicofemoral arterial occlusive disease are reported. Operative procedures were carried out on a total of 294 limbs. On 87 of these, profunda revascularization was performed. The indication for surgery was advanced ischemia in 50% of the profunda revascularization patients and in 20.5% of the patients with superficial femoral arteries open or reconstructed. Dacron bypass graft was used in 99 reconstructions and ilicofemoral or femorofemoral vein graft in 8 cases. Endarterectomy was carried out in 83 cases. The overall operative mortality rate was 5.3%, renal failure being the most common cause of death. The 5-year survival rate was 73.5%. The rate of primary thrombosis was 2.6%. The 5-year cumulative patency rate of all aorto-ilicofemoral reconstructions was 91.3%. In the profunda revascularization group the corresponding percentage was 82.1%. There was no difference in the patency rate between reconstructions using Dacron graft or endarterectomy. The symptomatic results were good also in the profunda revascularization group, 93% of patients having relieved symptoms as an initial result of surgery. There were seven major amputations in 6 patients during the follow-up time and 5 patients needed further femoropopliteal reconstruction. It can be said that in most cases profunda revascularization is sufficient for satisfactory clinical results.