The role of profunda femoris revascularization in aortofemoral surgery. An analysis of factors affecting graft patency

Abstract

Background: To determine the long-term results of aortofemoral grafts using the profunda femoris artery as an outflow vessel and to determine the factors affecting the outcome of these procedures.

Design: Prospective study.

Methods: From 1980 to 1993, 224 profundoplasties were performed as an adjunctive outflow procedure of aortofemoral grafts in 180 patients. There were 167 men and 13 women with a mean age of 63.7 years. Severe claudication was the indication for operation in 147 limbs (65.6%), and critical ischemia in 77 (34.4%). Good runoff was present in 159 limbs (71%), while poor run-off in 65 (29%). Profundoplasty was 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.

Results: 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 90.1% 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 predictive of inferior longterm results namely; critical ischemia, poor run-off, extended profundoplasty and vein patch used for the profundoplasty.

Conclusions: Angioplasty of the profunda femoris artery is a durable outflow procedure for aortofemoral graft surgery, when the above mentioned risk factors are absent; however when they do exist, the use of arterial patch for profundoplasty may improve the prognosis.