Revascularization of the profunda femoris artery for limb salvage

The clinical outcome of 88 profundaplasties in 70 patients operated upon during the period 1978 to 1982 was related to indications for operation, status of arterial run-off, influence of a concomitant inflow procedure, and changes in Doppler ankle-brachial index (ABI). Operative procedures were performed for rest pain (49 limbs), ulceration (24 limbs), and gangrene (13 extremities). Primary profundaplasty (PP) was performed in 26 (29%) cases. Sixty-two procedures (71%) were inflow profundaplasties (IP) performed in conjunction with other proximal reconstructions. Overall clinical success was achieved in 67 extremities (76%). When the operation was performed for rest pain, and the arterial run-off was good, success rate was 78 per cent and 79 per cent, respectively, as compared to 51 per cent and 57 per cent for ulceration/gangrene and poor arterial run-off. For PP, satisfactory outcome was noted in 69 per cent as compared to 79 per cent in IP. In the clinically successful profundaplasties, mean preoperative ABI was 0.29 and increased significantly to 0.53 postoperatively (P = 0.04). In the clinical failures, mean preoperative ABI was 0.32, and postoperative ABI was 0.38, which was not statistically significant (P greater than 0.05). Profundaplasty is a reliable operation particularly when the indication is rest pain, and the arterial run-off is good. Poor results can be anticipated when the procedure is performed for tissue loss, or if the arterial run-off is poor. Clinical outcome for the PP and IP groups were comparable.