Isolated profundaplasty for limb salvage.

Area of Science:

• Vascular Surgery
• Reconstructive Surgery
• Peripheral Artery Disease

Background:

• Severe stenosis of the deep femoral artery (DFA) and superficial femoral artery (SFA) occlusive disease significantly impacts limb viability.
• Limb salvage in patients with critical limb ischemia remains a significant clinical challenge.

Purpose of the Study:

• To evaluate the efficacy of profundaplasty as a primary limb salvage procedure in patients with severe femoropopliteal occlusive disease.
• To assess the long-term patency rates and functional outcomes following profundaplasty.

Main Methods:

• Fifty-six profundaplasties were performed on 54 patients with >50% DFA stenosis and SFA occlusive disease.
• Outcomes including ulcer healing, rest pain relief, necrosis healing, arterial patency, and limb salvage were retrospectively analyzed.
• The profundapopliteal collateral index (PPCI) was used to predict limb salvage.

Main Results:

• Profundaplasty resulted in ulcer healing in 53%, rest pain relief in 32%, and necrosis healing in 35% of patients.
• Cumulative deep femoral artery patency was 49% at 3 years and 21% at 5 years, with limb salvage rates of 49% and 36%, respectively.
• A PPCI ≤ 0.19 accurately predicted limb salvage (91%), while other clinical factors lacked predictive value.

Conclusions:

• Isolated profundaplasty is an effective initial procedure for selected limb salvage candidates, offering an alternative to amputation or high-risk bypass.
• Effective profunda femoris artery perfusion is crucial for knee joint preservation and functional rehabilitation when amputation is necessary.
• Profundaplasty facilitates below-knee amputations, enabling high rates of prosthetic ambulation (84%).