Profunda femoris bypass for secondary revascularization

Fourteen patients with critically ischemic lower limbs due to occlusion of a previous graft underwent revascularization using the profunda femoris artery as an inflow or outflow conduit at, or distal to, its first major perforating branch. This approach reduced the difficulties encountered during secondary procedures caused by intense scarring, distorted local anatomy and progressive atherosclerosis. Among the 14 patients, five required proximal secondary reconstructions, seven required distal reconstructions and two needed both proximal and distal combined reconstsructions. Technical factors believed to be important included the use of vein grafts whenever possible, loupe magnification, gentle vascular occlusion to prevent disruption of plaques and later trauma provoked atheroma formation and fine polypropylene sutures. Reinforced polytetrafluoroethylene was favored when the vein was not available. All procedures resulted in immediate limb salvage. Doppler angle-to-arm pressure ratios increased from a mean of 0.27 +/- 0.05 S.E.M. preoperatively to 0.80 +/- 0.06 S.E.M. postoperatively. Current follow-up time ranges from two to 24 months with only one failure, at five months, which required amputation. Profunda bypass is a excellent option for secondary revascularization of the lower extremity.