Remote profunda femoral bypass for limb salvage

Patients with patency of the distal segment of the profunda femoral arteries can be subjected to a direct end-to-side bypass with either tissue or synthetic grafts to increase blood flow to the lower extremity. The effectiveness and durability of this procedure will be enhanced by patency of the popliteal artery. Diffuse profunda femoris disease, popliteal or tibial peroneal obliterative disease and gangrenous lesions tend to militate against the success of this operation as an isolated procedure without augmenting flow to the distal part of an artery in the leg. Of 18 remote profunda femoris bypasses performed during a four year period, early amputation was required in two patients because of inadequate distal flow and the inability to establish downstream reconstruction. In one patient, an early bypass to the peroneal artery was required following closure of the profunda femoris bypass. The remaining 15 bypasses resulted in limb salvage and significant relief of symptoms. Three patients subsequently required secondary downstream reconstructions. The profunda femoris is surgically accessible for a long length and can serve as an adequate source of blood to the leg and foot in selected patients.