Limb salvage by extended profundaplasty of occluded deep femoral arteries.

This report presents our experience with extended profundaplasty as an outflow procedure for limb salvage in patients with occluded common and profunda femoris arteries. During a 5 year period at Salem Hospital, 15 limbs in 11 patients were revascularized by a variety of inflow procedures combined with extended endarterectomy and patch grafting of an occluded profunda femoris artery. All patients presented with rest pain, ischemic ulcers, or gangrenous toes. Patients with acute embolic disease or thrombosis of a limb of a graft which required immediate reconstruction were excluded from this study. Preoperative arteriograms revealed no patent femoral or graftable popliteal vessels but did demonstrate collateral circulation, specifically portions of the circumflex femoral arteries and muscular branches of the profunda. Operation was undertaken to disobliterate the profunda and reinstitute direct perfusion of the collateral bed. In all cases it was possible to endarterectomize the profunda to eliminate distal spared vessel and to open most of the profunda branches. There was no operative mortality. Follow-up revealed 87 percent limb salvage and 80 percent patency at 1 year. At 2.5 years limb salvage was 77 percent and reconstruction has remained patent in 60 percent of the limbs. These results compare favorably with series that have reported reconstructions for profunda stenosis alone. These preliminary data suggest that endarterectomy and long patch grafting of the proximally occluded profunda may have merit in providing worthwhile palliation in a small subset of patients with advanced occlusive disease.