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OBJECTIVES - The profunda femoris artery (PFA) is a primary vessel for maintainance of collateral flow to the distal lower limb in patients with critical limb ischemia (CLI). Via cruciate and genicular arteries originating from internal iliac and popliteal arteries, respectively, the PFA is a crucial, and sometimes last source of limb perfusion in CLI patients, particularly when the superficial femoral artery (SFA) and popliteal artery are singularly or concomitantly occluded. Nevertheless, PFA revascularization is not often mentioned as a first line treatment among interventionalists in CLI patients. The following study evaluates these specific patients, their pattern of disease, their history of revascularization and ultimate outcomes upon PFA revascularization.
METHODS - Review of all PFA or common femoral artery (CFA) endarterectomy procedures between the dates of September 2008 and September 2014 was performed. 194 procedures were identified and reviewed. Cases performed for indications other than limb threatning ischemia were removed from analysis. Cases involving patent superficial femoral outflow or concomitant infrainguinal bypass were also removed from analysis. This left 44 limbs in 41 patients who underwent isolated profundal revascularization for treatment of limb threatning ischemia.
RESULTS - Among the cohort, 57% presented with rest pain, 20% with ulceration, 11% with acute onset limb ischemia and 11% with gangrene. Of our population, 75% underwent combined CFA/PFA endarterectomy, 16% isolated PFA endarterectomy and 9% isolated CFA endarterectomy. 52% required “extensive” PFA endarterctomy with division of the crossing vein and extension to the primary profundal bifurcation. 30 day mortality was 0%. Overall, 91% of patients realized symptom resolution and/or healing/limb salvage after intervention. Among these patients, average post-operative ankle brachial indicies increased only 0.15 relative to pre-operative indices. Among patients presenting with rest pain, all achieved both limb salvage and symptom resolution. None presenting with rest pain required further infrainguinal revascularization on follow-up. Alternatively, patients with acute ischemia or tissue loss had a 79% rate of limb salvage during the first year after intervention with need for secondary infrainguinal revascularization in 21%.
CONCLUSIONS - This retrospective review suggests that PFA revascularization for treatment of rest pain has an excellent success rate. Alternatively, PFA revascularization for tissue loss or acute ischemia appears to be a reasonable option though close follow-up and a low threshold for further revascularization is advisable.