Isolated profundaplasty in critical limb ischaemia--still of any use?

Because of the improved quality of peripheral bypass surgery, the role of isolated profundaplasty in revascularisation of the critically ischaemic limb has become very limited. This retrospective study of 72 isolated profundaplasties performed for critical limb ischaemia revealed a clinical improvement 1 year postoperatively of 39% in the period 1978-1983 and of only 9% between 1984-1990. In the total period, patient survival after 1 year was 81% and limb salvage 60%. Clinical, haemodynamic and arteriographic parameters were analysed for their predictive value of clinical success. The presence of tissue necrosis or ulceration (clinical stage IV) affected clinical outcome negatively (p < 0.05). Risk factors and indicators for arteriosclerotic disease, age of the patient and ankle-brachial systolic pressure index (ABI) had no significant predictive value. Evaluation of the preoperative arteriographies revealed that only the aspect of the profunda femoris artery beyond its orifice was of significance: there was a strong relationship between the absence of obstructive disease in this part of the artery and clinical improvement (p < 0.005). These two significant parameters may be guidelines when considering an isolated profundaplasty as an alternative in the treatment of critical limb ischaemia. However, in the presence of other treatment possibilities nowadays, especially bypass surgery, the procedure appears to offer a very poor success rate.