Abstract
Background
Surgical profundaplasty (SP)is used mainly as an adjunct to endovascular management of peripheral vascular disease (PAD) today. Results from earlier series of profundaplasty alone have been controversial, especially regarding its hemodynamic effect. The question is: Can profundaplasty alone still be useful? Our aim was to evaluate its role in the modern management of vascular patients.
Methods
This was a retrospective outcome study. A consecutive series of 97 patients (106 legs) from January 2000 through December 2003 were included. In 55 (52%) legs, the superficial femoral artery was occluded. These patients were included in the current analysis. Of these patients 14 (25%) were female. Mean age was 71 ((11) years. Nineteen (35%) were diabetic. The indication for operation was claudication in 29 (53%), critical leg ischemia (CLI) in 26 (47%), either with rest pain in 17 (31%), or ulcer/gangrene in 9 (16%). Endarterectomy with patch angioplasty with bovine pericardium was performed in all cases. Mean follow-up was 33 ( 14 months. Mean preoperative ankle brachial index (ABI) was 0.6. Sustained clinical efficacy was defined as upward shift of 1 or greater on the Rutherford scale without repeat target limb revascularization (TLR) or amputation. Mortality, morbidity, need for TLR, or amputation were separate endpoints.
Results
Postoperatively, ABI was significantly improved (mean = 0.7), in 24 (44%) by more than 0.15. At three years, cumulative clinical success rate was 80%. Overall, patients with claudication had a better outcome than those with CLI (p = 0.04). Two (4%) major amputations and 2 (4%) minor ones were performed, all in patients with CLI. None of the 9 (16%) ulcers healed.
Conclusion
Profundaplasty is still a valuable option for patients with femoral PAD and claudication without tissue loss. It is a straightforward procedure that combines good efficacy with low complication rates. Further endovascular treatment may be facilitated. It is not useful for patients with the combination of critical ischemia and tissue loss.
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References
Earnshaw J (2005) Surgical options for treatment of profunda stenosis. In: Greenhalgh RM (ed) Towards Vascular and Endovascular Consensus. London, BIBA, pp 431–438
Martin P, Renwick S, Stephenson C (1968) On the surgery of the profunda femoris artery. Br J Surg 55:539–542
Rutherford R, Baker J, Ernst C, et al. (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26:517–538
Morris GC, Edwards W, Cooley D, et al. (1961) Surgical importance of the profunda femoris artery. Arch Surg 82:32–37
Leeds RH, Gilfillan RS (1961) Revascularisation of the ischemic limb. Arch Surg 82:45–51
Natali J (1962) By-pass using the deep femoral artery (technique and indications) J Chir (Paris) 83:565–580
Cotton LT, Roberts VC (1975) Extended deep femoral angioplasty an alternative to femoropopliteal bypass. Br J Surg 62:340–343
Martin P, Bouhoutsos J (1977) The medium term results after profundaplasty. Br J Surg 64:194–196
Jamieson C (1989) Reconstruction of, and to, the profunda femoris artery. In: Greenhalgh RM (ed) Vascular Surgical Techniques: An Atlas. London, WB Saunders, pp 220–227
Meyer E, Adar R (1981) Comparison of extended deep femoral angioplasty and femoropopliteal bypass graft in severe ischemia of the leg. World J Surg 5:119–122
Fugger R, Krethschmer G, Schemper M, et al. (1987) The place of profundaplasty in surgical treatmen of superficial femoral artery occlusion. Eur J Vasc Surg 1:187–191
Jamil Z, Hobson RW, Lynch TG, et al. (1984) Revascularization of the profunda femoris artery for limb salvage. Am Surg 50:109–111
Van der Plas JP, Van Dijk J, Tordoir JH, et al. (1993) Isolated profundaplasty in critical limb ischemia – still of any use? Eur J Vasc Surg 7:54–58
Kalman PG, Johnston KW, Walker PM (1990) The current role of isolated profundaplasty. Cardiovasc Surg 31:107–111
Sutter T, Jauch KW, Erlewein G, et al. (1990) Long-term results of 370 profundaplasties. Vasa 19:307–310
McCoy DM, Sawchuk AP, Shuler JJ, et al. (1989) The role of isolated profundaplasty for the treatment of rest pain. Arch Surg 124:221–224
Rollins DL, Towne JB, Bernhard VM, et al. (1985) Isolated profundaplasty for limb salvage. J Vasc Surg 2:585–590
Diehm N, Savolainen H, Mahler F, et al. (2004) Does deep femoral artery revascularization as an isolated procedure play a role in chronic critical limb ischemia? J Endovasc Ther 11:119–124
Miksic K, Novak B (1986) Profunda femoris revascularization in limb salvage. J Cardiovasc Surg 27:544–552
Rosenthal D, Martin JD, Smeets L, et al. (2006) Remote superficial femoral artery endarterectomy and distal aSpire stenting: results of a multinational study at three-year follow-up. J Cardiovasc Surg (Torino) 47:385–391
Moll F, Ho G, Joosten P et al (1996) Endovascular remote endarterectomy in femoropopliteal long segmental occlusive disease. A new surgical technique illustrated and preliminary results using a ring strip cutter device. J Cardiovasc Surg (Torino) 37(3 Suppl 1):39–40
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Savolainen, H., Hansen, A., Diehm, N. et al. Small Is Beautiful: Why Profundaplasty Should Not Be Forgotten. World J Surg 31, 2058–2061 (2007). https://doi.org/10.1007/s00268-007-9188-y
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DOI: https://doi.org/10.1007/s00268-007-9188-y