Femorofemoral grafts: the role of concomitant extended profundaplasty.
Twenty-one femorofemoral grafts were placed in high risk patients with symptomatic, unilateral, iliofemoral, arterial occlusive disease. There was 100 per cent immediate postoperative relief of ischemia or improvement in claudication. Three late below-knee amputations have been performed. All other living patients had healed extremities and were ambulatory at last follow-up. Cumulative graft patency determined by the life table method was 95 per cent at twenty-four months. The physiologic "steal" created by a femorofemoral bypass with donor limb and/or outflow stenosis must be considered to prevent clinical donor limb functional impairment. A gradient of 10 mm Hg or less between the radial artery mean pressure and the donor femoral artery ensured adequate donor artery flow without regard to angiographic a-pearance of the donor artery. The crucial technical problem in patients operated on for ischemia was reconstruction of adequate outflow. All but one patient required at least minimal profunda endarterectomy, and nine of seventeen (53 per cent) required concomitant extended profundaplasty procedures.
D000367:Age Factors; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001158:Arteries / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D014182:Transplantation, Autologous