Results of Infrageniculate Bypasses Using the Profunda Femoris Artery as Inflow Source

Area of Science:

• Vascular Surgery
• Arterial Revascularization
• Critical Limb Ischemia

Background:

• The common femoral artery is the standard inflow source for infrainguinal bypass grafting.
• When inaccessible, the profunda femoris artery (PFA) presents a viable alternative for distal arterial revascularization.
• Critical limb ischemia (CLI) necessitates effective revascularization strategies.

Purpose of the Study:

• To evaluate the outcomes of infrageniculate bypass grafting using the PFA as the inflow source for patients with CLI.
• To assess the safety and efficacy of PFA inflow in complex arterial revascularization procedures.

Main Methods:

• Retrospective study of 68 patients (mean age 74 years) undergoing infrageniculate bypass grafting with PFA inflow between 1994 and 2016.
• PFA exposure at Scarpa's triangle (56%) or mid-thigh (44%).
• Distal anastomosis to various infrapopliteal arteries; reversed great saphenous vein (91%) or PTFE graft (9%) used.

Main Results:

• Low operative mortality (3%) and morbidity (4%).
• At 60 months, overall survival was 53%, primary patency was 59%, and limb salvage rate was 77%.
• High limb salvage rates indicate the effectiveness of PFA inflow for CLI.

Conclusions:

• The profunda femoris artery (PFA) is a highly effective inflow source for infrageniculate revascularization.
• PFA inflow should be considered a key technique for vascular surgeons managing CLI, even with endovascular options.
• This approach provides durable results for limb salvage in challenging cases.