Rollins D L, Towne J B, Bernhard V M, Baum P L
J Vasc Surg. 1985 Jul;2(4):585-90. doi: 10.1067/mva.1985.avs0020585.
Fifty-four patients underwent 56 profundaplasties for limb salvage. All had stenosis greater than 50% in diameter of the deep femoral artery and associated superficial femoral artery occlusive disease. After profundaplasty, ischemic ulcers healed in 9 of 17 (53%) patients. Rest pain was relieved in 6 of 19 (32%) and areas of ischemic necrosis healed in 7 of 20 (35%). Cumulative patency of the deep femoral artery was 49% at 3 years but fell to 21% at 5 years, whereas cumulative limb salvage was 49% and 36%, respectively. Eleven of the required 28 amputations were performed in the immediate postoperative period. Profundaplasty was used to lower the amputation level and preserve the knee joint in six patients. The other five early amputations occurred in severely ischemic limbs without distal vessels suitable for bypass. The profundaplasty remained patent in all 19 patients who underwent below-knee amputation and 16 (84%) became ambulatory with a prosthesis. Hemodynamic data provided by determination of the profundapopliteal collateral index predicted limb salvage in 10 of 11 (91%) of limbs when the index value was less than or equal to 0.19. Other clinical criteria, such as preoperative ankle-brachial index and the presence of diabetes mellitus, had no predictive value. Isolated profundaplasty for limb salvage is an effective first procedure for selected patients and provides a reasonable alternative to primary amputation or high-risk distal bypass. When amputation is inevitable, effective perfusion of the profunda femoris artery is essential for preservation of the knee joint and results in a high degree of functional rehabilitation.
54例患者接受了56次保肢股深动脉成形术。所有患者股深动脉直径狭窄均超过50%，并伴有股浅动脉闭塞性疾病。股深动脉成形术后，17例患者中的9例（53%）缺血性溃疡愈合。19例患者中的6例（32%）静息痛得到缓解，20例患者中的7例（35%）缺血性坏死区域愈合。股深动脉3年的累积通畅率为49%，但5年时降至21%，而保肢的累积成功率分别为49%和36%。28例所需截肢手术中有11例在术后即刻进行。股深动脉成形术用于降低6例患者的截肢平面并保留膝关节。另外5例早期截肢发生在严重缺血且无适合旁路移植的远端血管的肢体。在所有接受膝下截肢的19例患者中，股深动脉成形术均保持通畅，16例（84%）患者安装假肢后能够行走。当腘深侧支指数小于或等于0.19时，通过测定腘深侧支指数获得的血流动力学数据可预测11例肢体中的10例（91%）保肢情况。其他临床标准，如术前踝肱指数和糖尿病的存在，均无预测价值。对于选定的患者，单纯股深动脉成形术作为保肢的首次手术是有效的，并且为一期截肢或高风险的远端旁路移植提供了合理的替代方案。当截肢不可避免时，股深动脉的有效灌注对于保留膝关节至关重要，并可实现高度的功能康复。
