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[Profundoplasty in treatment of patients with chronic lower limb ischaemia]
A V Gavrilenko1, N N Al-Yousef2, Wang Xiaochen3
1Russian Research Centre of Surgery named after Academician B.V. Petrovsky, Moscow, Russia; First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia.
Insights
Profundoplasty effectively preserves lower limbs in chronic lower limb ischemia stages IIB and III. Deep femoral artery diameter and distal bed condition significantly impact long-term outcomes.
Area of Science:
- Vascular Surgery
- Peripheral Vascular Disease
- Arterial Reconstruction
Background:
- Superficial femoral artery occlusion is common in peripheral vascular disease.
- Femoropopliteal bypass grafting yields poor results for crural artery lesions.
- The deep femoral artery is crucial for lower limb perfusion in such cases.
Purpose of the Study:
- To evaluate the effectiveness of profundoplasty in patients with superficial femoral artery occlusion and chronic lower limb ischemia.
- To identify factors influencing the outcomes of profundoplasty.
Main Methods:
- 166 patients with TASC II B, C, D femoropopliteal lesions underwent profundoplasty.
- Patients were grouped by chronic lower limb ischemia stage: IIB (95), III (56), and IV (15).
- Outcomes were assessed over 5 years, analyzing amputation rates and influencing factors.
Main Results:
- Amputation was avoided in 94.7% of stage IIB and 83.9% of stage III patients.
- All 15 stage IV patients required amputation due to an unsatisfactory distal bed (p=0.028).
- Deep femoral artery diameter (p=0.045) and distal arterial bed status (p=0.02) significantly influenced 5-year outcomes.
Conclusions:
- Profundoplasty is effective for stages IIB and III chronic lower limb ischemia.
- Deep femoral artery diameter and distal bed condition are key predictors of profundoplasty success.
Abstract:
Occlusion of the superficial femoral artery is a frequently encountered pathology in peripheral vascular disease. In patients with chronic lower limb ischaemia in a lesion of crural arteries the results of femoropopliteal bypass grafting are unsatisfactory, therefore, the deep femoral artery becomes the decisive collateral pathway for perfusion of the lower extremity.
Patients And Methods:
The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 - 95 patients with stage II B, Group 2 - 56 patients with stage III, and Group 3 - 15 patients with stage IV.
Results:
Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 - in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years.
Conclusion:
Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.
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