Profundapopliteal collateral index. A guide to successful profundaplasty

Area of Science:

• Vascular Surgery
• Cardiovascular Medicine
• Medical Engineering

Background:

• Critical limb ischemia (CLI) poses a significant challenge, often requiring complex surgical interventions.
• Profundaplasty is a key procedure for improving profunda femoris artery (PFA) blood flow.
• Evaluating the efficacy of profundaplasty, especially in conjunction with other revascularization techniques, is crucial for limb salvage.

Purpose of the Study:

• To assess the effectiveness of profundaplasty in limb salvage for patients with CLI.
• To correlate surgical outcomes with hemodynamic measurements, specifically segmental pressures.
• To determine the predictive value of the profunda-popliteal collateral index (PPCI) for profundaplasty success.

Main Methods:

• Retrospective analysis of 232 limbs (163 patients) undergoing profundaplasty.
• Correlation of limb salvage rates with combined inflow procedures versus profundaplasty alone.
• Calculation of the profunda-popliteal collateral index (PPCI) using segmental pressure measurements.
• Comparison of PPCI values between successful and unsuccessful limb salvage groups.

Main Results:

• Profundaplasty combined with inflow procedures achieved an 83% limb salvage rate.
• Profundaplasty alone resulted in a 48% limb salvage rate.
• A lower mean PPCI (0.18) was associated with successful limb salvage when profundaplasty was performed alone, compared to a higher PPCI (0.46) in unsuccessful cases.
• PPCI demonstrated an inverse correlation with circulatory improvement.

Conclusions:

• Profundaplasty is more effective for limb salvage when combined with inflow procedures.
• The PPCI is a valuable, non-invasive tool for predicting the hemodynamic significance of geniculate collaterals.
• PPCI can guide patient selection for profunda femoris artery repair, optimizing surgical outcomes.