The place of profundaplasty in the surgical treatment of superficial femoral artery occlusion

Small Is Beautiful: Why Profundaplasty Should Not Be Forgotten

“…Cotton and Roberts [7] reported success in 59%, treating 68 patients with severe claudication, rest pain, and ulcers. Fugger et al [11] reported improvement in 38% in Fontaine stage III ischemia and 28% in IV. Amputations could not be avoided.…”

The Role of Isolated Profundaplasty in Attempts to Lower the Level of Amputation in Critical Limb Ischemia

“…According to some authors, the chances for healing after below-knee amputations are higher in primary amputations than after failed revascularization (3,15); however, according to other authors, these chances are equal (16). An increase in lower extremity blood flow in the deep femoral artery and collateral popliteal network is one of the methods that could augment stump healing and salvage of the function of the knee joint (8,9,10). Isolated profundaplasty was previously considered as almost an alternative method of revascularization in lower extremities in cases of occluded femoro-popliteal segment.…”

“…Currently, the contribution of profundoplasty to the treatment of critical limb ischemia is markedly diminished, because of the increased use of femorodistal bypass surgery (17,18). Improvement is possible in the selected group of patients with less severe ischemia if precise criteria of patient qualification for profundaplasty based on segmental pressure measurements and arteriographic studies are followed (9,10,(19)(20)(21)(22). In the treatment of CLI, profundaplasty allows for only unsatisfactory rates of ulcer healing and relief of other pain (17,19,23).…”

“…Only approximately 55% of these stumps heal within the first 100 days, and the rate of conversion to above-knee amputation is 9-25% (2, 4-7). The reports published some 30 years ago had recommended profundaplasty (PF) as a procedure that allowed preservation of the knee joint in some of the patients (8,9,10). The issue of reconstruction of the flow through the collateral network of the knee in the situation of inevitable amputation was neglected.…”

The Current Role of Profundaplasty in Complex Arterial Reconstruction

“…For patients with femoral-popliteal occlusive disease, the presence of adequate collaterals from the profunda femoris to patent popliteal and/or tibial arteries is requi-site to achieve acceptable results with isolated profundaplasty. 11,111,19 Because the success of isolated profundaplasty is dependent on recruiting the maximum number of branch vessels that have been obstructed, the surgeon must be willing to undertake extended profundaplasty. The inadequacy of the procedure for patients with a gangrenous foot ulcer supports previous studies, which demonstrated that the success of profundaplasty in patients with ischemic tissue loss is poor.…”