Profundapopliteal collateral index. A guide to successful profundaplasty.

The response to profundaplasty was evaluated in 232 limbs (163 patients) and correlated with segmental pressures and operative flow measurements. Of 150 limbs operated on for rest pain or ischemic necrosis, an inflow procedure (aortofemoral, femorofemoral, etc) combined with profundaplasty was successful in achieving limb salvage in 80 of 96 limbs (83%), but after profundaplasty alone only 26 of 54 limbs (48%) were salvaged. Using segmental pressure measurements, an index of the resistance of the profundapopliteal collateral system (PPCI) was calculated from the segmental pressure decrease across the knee, and demonstrated an inverse correlation with circulatory improvement. When profundaplasty was performed alone, successful limb salvage was associated with a mean PPCI of .18, compared with .46 in the group with unsatisfactory results. The PPCI is an accurate predictor of the hemodynamic potential of the geniculate collaterals and is useful in the selection of patients for profunda repair.