Extended autogenous profundaplasty and aortofemoral grafting: an alternative to synchronous distal bypass.

The success of aortofemoral reconstruction in patients with superficial femoral artery occlusion depends on the restoration of satisfactory inflow to the profunda femoris artery (PFA). When significant occlusive disease exists within this vessel, two options exist: femoral-distal bypass or reconstruction of the PFA. In 165 aortofemoral reconstructions for occlusive disease, 29 limbs (9%) underwent an extended autogenous profundaplasty. The cumulative 5-year patency rate of autogenous reconstructions was 86%, with a 72% limb salvage rate without distal bypass. Two limbs were amputated early for sepsis with patent grafts. One early and one late femoral-popliteal bypass was performed. Groin wound complications, primarily lymphoceles and wound edge necrosis, were numerous (38%). There were no graft infections. Relief of ischemic symptoms was achieved regardless of patency of the popliteal artery. Furthermore, noninvasive testing, clinical history, and angiography failed to accurately predict the results. In patients with advanced PFA disease undergoing aortofemoral grafting, the extended autogenous profundaplasty is a durable procedure with excellent relief of ischemic symptoms.