Profunda femoris revascularization in limb salvage

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Peripheral Artery Disease

Background:

• Profunda femoris artery (PFA) plays a crucial role in lower limb perfusion.
• Critical limb ischemia (CLI) often involves complex PFA disease.
• Revascularization strategies for CLI are essential for limb salvage.

Purpose of the Study:

• To evaluate the outcomes of profunda femoris artery reconstructions.
• To identify factors influencing the success of profundaplasty.
• To assess the limb salvage rates associated with PFA repair.

Main Methods:

• Retrospective analysis of 282 PFA reconstructions (1971-1981).
• Follow-up in 212 patients (75.1%) for at least two years.
• Arteriographic evaluation in 92 cases; analysis of inflow, PFA disease extent, run-off, and ischemic lesion extent.

Main Results:

• Indications for revascularization were Stages III and IV CLI in 86% of cases.
• Inflow correction was needed in 60.3% of PFA reconstructions.
• Two-year cumulative limb salvage was 86.8% with inflow correction and profundaplasty vs. 56.5% for PFA repair alone.
• PFA repair lowered amputation levels in below-knee amputations.

Conclusions:

• Profundaplasty is a valuable option for CLI, particularly when combined with inflow correction.
• Factors like inflow, PFA disease severity, and distal run-off significantly impact outcomes.
• Profundaplasty should be considered even for patients unsuitable for other revascularization surgeries.