Small is beautiful: why profundaplasty should not be forgotten

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease Management

Background:

• Surgical profundaplasty (SP) is often an adjunct to endovascular treatments for peripheral artery disease (PAD).
• Previous studies on SP alone yielded controversial results regarding its hemodynamic effects.
• The study aimed to reassess the utility of SP as a standalone procedure in contemporary vascular patient management.

Purpose of the Study:

• To evaluate the role and efficacy of surgical profundaplasty as a sole intervention for femoropopliteal arterial disease.
• To determine if SP can still be a useful standalone procedure in modern vascular surgery.
• To assess outcomes in patients with superficial femoral artery occlusions treated with SP.

Main Methods:

• A retrospective analysis of 97 patients (106 legs) undergoing SP for superficial femoral artery occlusions between 2000 and 2003.
• Patient data included demographics, indication for surgery (claudication vs. critical limb ischemia), and preoperative ankle-brachial index (ABI).
• Sustained clinical efficacy was defined by Rutherford scale improvement without repeat revascularization or amputation; outcomes included mortality, morbidity, and amputation rates.

Main Results:

• Postoperative ABI improved significantly (mean 0.7), with 44% showing an increase >0.15.
• A 3-year cumulative clinical success rate of 80% was achieved.
• Patients with claudication had better outcomes than those with critical limb ischemia (CLI); amputations and non-healing ulcers were confined to CLI patients.

Conclusions:

• Surgical profundaplasty remains a valuable standalone option for femoropopliteal PAD patients experiencing claudication without tissue loss.
• The procedure is technically straightforward, demonstrating good efficacy and low complication rates.
• SP is not advisable for patients with critical limb ischemia and associated tissue loss.