[Pro and contra profundaplasty (author's transl)]

The profundaplasty has recently advanced to a widely used surgical approach for revascularisation of the lower extremities, both for claudication and limb salvage. The effectiveness of this simple time saving procedure depends on a critical selection of patients and the use of an improved surgical technique. Main prerequisites are the simultaneous aorto-iliac inflow repair, using thromboendarterectomy or bypass, the patency of the so-called "receptor segment" of the popliteal artery and a sufficient run- off in the distal arterial tree. An additional lumbar sympathectomy has proved as a protective adjunct which results in an additional increase of flow in the restored deep femoral artery. In combined occlusive lesions of the aorto-iliac and femoro-popliteal segment the late results of a proximal inflow repair in combination with profundaplasty and lumbar sympathectomy are significantly superior to the total repair of both arterial segments. A profundaplasty is contraindicated if this artery is seriously diseased or in the presence of total occlusion of the popliteal artery (receptor segment) and of more than two main arteries below the knee. This is the place where long distal grafts are still justified for limb salvage. In over 80% of patients with arterial occlusive disease of the leg arteries the profundaplasty (with or without aorto-iliac inflow-repair) has proved as an effective alternative to time-consuming extensive arterial reconstructions with equivocal outcome.