Importance of the profunda femoral artery in distal limb revascularisation.

The profunda femoral artery (PFA) was recognised in the early 1960s as an essential artery to maintain perfusion in the lower limb. The aim of this retrospective study was to analyse the results obtained with aortobifemoral bypass surgery (ABF) where the distal perfusion was solely dependent on the PFA. An evaluation was made of 240 ABFs done between January 1988 and May 1995. This represented a combination of operations done by either the vascular unit at the HF Verwoerd teaching hospital or by Dr Van Marle privately. In 56 cases only the PFA was available for distal anastomoses in one or both limbs, giving a total of 80 PFA anastomoses. Evaluation was based on pre- and postoperative ankle brachial pulse indexes (ABPI). There were 3 deaths and 1 amputation in the early postoperative period. Over an average follow-up period of 32 months (1 month-63 months) 76 limbs were assessed. At initial presentation 30% of the patients had rest pain and 2 already had gangrenous changes. Mean pre-operative ABPI was 0.5. A further femoral-popliteal bypass was required within 1 year for 6 of the patients. The average postoperative ABPI was 0.86, giving a 73.2% average improvement. We therefore concluded that good results can be achieved when the PFA is used for distal anastomosis in ABF bypass surgery.