The role of profunda femoris revascularization in aortofemoral surgery. An analysis of factors affecting graft patency.
BACKGROUND
To determine the long-term results of aortofemoral grafts using the profunda femoris artery as an outflow vessel and to determine the factors affecting the outcome of these procedures.


METHODS
Prospective study.


METHODS
From 1980 to 1993, 224 profundoplasties were performed as an adjunctive outflow procedure of aortofemoral grafts in 180 patients. There were 167 men and 13 women with a mean age of 63.7 years. Severe claudication was the indication for operation in 147 limbs (65.6%), and critical ischemia in 77 (34.4%). Good runoff was present in 159 limbs (71%), while poor run-off in 65 (29%). Profundoplasty was extended distally in 67 cases (29.9%), while in the remaining 157 (70.1%) it was limited to the proximal portion of the artery. Arterial and venous patches were used alternatively for the profundoplasty.


RESULTS
The 30-day mortality was 1.6% and the 5-year and 9-year survival rate was 69.7% and 49.1% respectively. Primary graft patency was 87.2% in 5 years and 78.5% in 9 years, while secondary graft patency was 90.1% in 5 years and 81.4% in 9 years. Limb salvage rate was 92.7% in 5 years and 87.6% in 9 years. There were four factors which were predictive of inferior longterm results namely; critical ischemia, poor run-off, extended profundoplasty and vein patch used for the profundoplasty.


CONCLUSIONS
Angioplasty of the profunda femoris artery is a durable outflow procedure for aortofemoral graft surgery, when the above mentioned risk factors are absent; however when they do exist, the use of arterial patch for profundoplasty may improve the prognosis.
Bastounis
E
E
First Surgical Department, Medical School, University of Athens Laiko General Hospital, Greece.
Felekouras
E
E
Pikoulis
E
E
Hadjinikolaou
L
L
Georgopoulos
S
S
Balas
P
P
D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004691:Endarterectomy; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery*; D007511:Ischemia / Q000601:surgery*; D007866:Leg / Q000098:blood supply; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014654:Vascular Patency