THE CURRENT ROLE OF PROFUNDAPLASTY IN COMPLEX ARTERIAL RECONSTRUCTION

By use of direct surgical procedures, including endarterectomy and pat ch angioplasty, the reconstructed profunda femoris artery has been emp loyed to treat symptoms of claudication from femoral-popliteal occlusi ve disease and to facilitate healing of amputations that spare the kne e joint. As the techniques of distal arterial bypass have become more sophisticated with improved long-term patency, the role of profundapla sty has changed. Sixty-eight reconstructions of the profunda femoris a rtery were reviewed for 51 patients with limb-threatening ischemia (69 %), claudication (28%), or infected prosthetic vascular grafts (3%). T hirty-three (49%) of the limbs had undergone 73 prior arterial reconst ructions. Forty-nine patients had inflow procedures performed at the t ime of the profundaplasty, and 13 had concomitant reconstruction of ar terial outflow. In only 6 cases was the procedure an isolated profunda plasty. Successful profundaplasty was defined as primary patency of th e 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 salva ge rate of 96% at four years. Isolated profundaplasty is seldom utiliz ed to treat critical ischemia of the lower extremity. The current role of profundaplasty places the procedure as an important adjunct to ach ieve long-term limb salvage and patency of complex vascular reconstruc tions.