THE ROLE OF PROFUNDA FEMORIS REVASCULARIZATION IN AORTOFEMORAL SURGERY - AN ANALYSIS OF FACTORS AFFECTING GRAFT PATENCY

Background. To determine the long-term results of aortofemoral grafts using the profunda femoris artery as an outflow vessel and to determin e the factors affecting the outcome of these procedures. Design. Prosp ective study. Methods. From 1980 to 1993, 224 profundoplasties were pe rformed as an adjunctive outflow procedure of aortofemoral grafts in 1 80 patients. There were 167 men and 13 women with a mean age of 63.7 y ears. Severe claudication was the indication far operation in 147 limb s (65.6%), and critical ischemia in 77 (34.4%). Good runoff was presen t in 159 limbs (71%), while poor run-off in 65 (29%). Profundoplasty w as extended distally in 67 cases (29.9%), while in the remaining 157 ( 70.1%) it was limited to the proximal portion of the artery. Arterial and venous patches were used alternatively for the profundoplasty. Res ults. The 30-day mortality was 1.6% and the 5-year and 9-year survival rate was 69.7% and 49.1% respectively. Primary graft patency was 87.2 % in 5 years and 78.5% in 9 years, while secondary graft patency was 9 0.1% in 5 years and 81.4% in 9 years. Limb salvage rate was 92.7% in 5 years and 87.6% in 9 years. There were four factors which were predic tive of inferior long-term results namely; critical ischemia, poor run -off, extended profundoplasty and vein patch used for the profundoplas ty. Conclusions. Angioplasty of the profunda femoris artery is a durab le outflow procedure for aortofemoral graft surgery, when the above me ntioned risk factors are absent; however when they do exist, the use o f arterial patch for profundoplasty may improve the prognosis.