Efficacy of isolated profundaplasty.

Profundaplasty has been advocated as an outflow procedure for threatened failure of aortobifemoral grafts as well as a primary procedure for severe claudication and limb ischemia. The authors reviewed their experience with 27 patients who underwent profundaplasty between 1978 and 1983; five patients (group 1) were treated for threatened or complete aortofemoral graft thrombosis while 22 patients (group 2) underwent profundaplasty as an isolated procedure to treat limb ischemia. Preoperative angiograms were assessed for the presence of five criteria associated with a favourable result from profundaplasty: stenosis of the orifice of the deep femoral artery greater than 50%; minimal disease of the distal artery; disease-free collaterals; reconstitution of a patent superficial femoral or popliteal artery; good popliteal outflow with at least one vessel patent to the foot. Profundaplasty was successful in 100% of group 1 patients but relieved symptoms or healed lesions in only 14% of those in group 2. In the latter group 64% required major amputation. The number of favourable angiographic criteria was similar in both groups. Isolated profundaplasty for limb salvage is not recommended. Angiographic criteria do not reliably identify the few patients who will benefit from profundaplasty alone. The principal role of the procedure is increasing outflow for an aortic graft.