Deep Femoral Artery Reconstruction

Abstract

The deep femoral artery (DFA) and superficial femoral artery (SFA) are the main outflow tracks used in reconstruction of the aortoiliac segment. The DFA can be used as an alternative source of inflow in arterial reconstruction in the lower limbs, particularly in reoperative procedures (Brewster et al. 1987; DePalma et al. 1980). Many patients who have ischemia that is severe enough to require bypass also have occlusion of the SFA. This occlusion usually begins at the adductor canal and may proceed up to the origin of the SFA. As a result, the SFA is the functional outflow even when the graft is attached to the common femoral artery (CFA). Therefore, the surgeon must visualize the orifice of the DFA at operation. When performing aortofemoral bypass for limb salvage, we often put a tongue of the distal aortofemoral bypass graft down onto the DFA. A DFA free of disease beyond the first centimeter will usually support an aortofemoral, axillary-to- femoral, or femoral-to-femoral graft even when the superficial femoral artery is entirely occluded. The distal end of the DFA has rich collaterals around the knee via the genicular arteries (see Fig. 6 in Chap. 1). In patients whose aortofemoral bypass has failed, the DFA is often the artery of choice to provide outflow. This chapter is limited to a discussion of reconstruction by grafting and endarterectomy of the DFA.