The current role of profundaplasty in complex arterial reconstruction

By use of direct surgical procedures, including endarterectomy and patch angioplasty, the reconstructed profunda femoris artery has been employed to treat symptoms of claudication from femoral-popliteal occlusive disease and to facilitate healing of amputations that spare the knee joint. As the techniques of distal arterial bypass have become more sophisticated with improved long-term patency, the role of profundaplasty has changed. Sixty- eight reconstructions of the profunda femoris artery were reviewed for 51 patients with limb-threatening ischemia (69%), claudication (28%), or infected prosthetic vascular grafts (3%). Thirty-three (49%) of the limbs had undergone 73 prior arterial reconstructions. Forty-nine patients had inflow procedures performed at the time of the profundaplasty, and 13 had concomitant reconstruction of arterial outflow. In only 6 cases was the procedure an isolated profundaplasty. Successful profundaplasty was defined as primary patency of the vascular reconstruction. By life table analysis, revascularizations utilizing profundaplasty had a primary patency of 81% at one year, 64% at two years, and 54% at four years. The series achieved a limb salvage rate of 96% at four years. Isolated profundaplasty is seldom utilized to treat critical ischemia of the lower extremity. The current role of profundaplasty places the procedure as an important adjunct to achieve long- term limb salvage and patency of complex vascular reconstructions.