Profundaplasty in the ischemic extremity

107 patients underwent vascular reconstruction for ischemic peripheral vascular disease distal to the inguinal ligament at the North Carolina Memorial Hospital from 1973 to 1979. All patients were evaluated with pre-operative Doppler arterial pressures and arteriography. 93 underwent femoral bypass grafting. 14 patients who were not felt to be candidates for bypass and were selected for primary profundaplasty form the subject of this report. Patients presented with a chief complaint of claudication, acute onset of rest pain secondary to acute occlusion or gangrene. Ankle/brachial ratio was as follows: Claudication, 0.56; chronic rest pain, 0.29; gangrene, 0.43, acute occlusion, 0.36. Outcome by patient group showed that both patients who presented with acute onset of rest pain had successful outcomes; 1 success and 2 patients with no change in symptoms in the group who presented with claudication; all patients with gangrene failed to improve and underwent major amputation. The best preoperative predictor was the patient's presenting complaint. Neither Doppler arterial pressures, the presence of diabetes nor arteriography were helpful in selecting patients for favorable outcomes. In our experience, few patients with severe peripheral vascular disease distal to the inguinal ligament unreconstructible by other means will benefit from primary profundaplasty. A possible exception are patients who present with acute arterial occlusion.