The Use of the Profunda Femoral Artery as the Sole Target Vessel to Bypass Aortoiliac Disease in Patients with Critical Limb Ischemia and Concomitant Unreconstructable Infrainguinal Disease (original) (raw)

2018, Annals of Vascular Surgery

Background: Critical limb ischemia (CLI) often results from multilevel occlusive disease. There are occasions where a patent profunda femoral artery (PFA) is the only target artery that can be used as outflow during reconstruction to bypass aortoiliac disease (AOID), with no further option for infrainguinal revascularization. We aim to report results of the use of PFA as the sole target vessel for the treatment of these patients. Methods: This is a retrospective, single-center study including CLI patients treated during 36 months. All procedures were included regardless of inflow site. The outcomes examined were hemodynamic improvement, clinical status change, amputation-free and overall survival, and patency of the prosthesis. Univariate analysis was performed to identify possible predictors of adverse outcomes. Results: Twenty-three patients and 27 limbs were included (2 female, mean age 70.6). Sixteen limbs presented rest pain and 11 tissue loss. Inflow was obtained from the axillary (n ¼ 9), contralateral femoral (n ¼ 8), abdominal aorta (n ¼ 2), thoracic aorta (n ¼ 1), ipsilateral external iliac (n ¼ 2), and contralateral external iliac artery (n ¼ 1). Immediately postoperatively anklebrachial index significantly increased from 0.15 (0e0.5) to 0.50 (0.25e0.9), (P-value < 0.001). Twenty-four limbs presented clinical improvement (3 minimally, 18 moderately, and 3 markedly improved) and 3 presented no change. During a mean follow-up of 15.8 (2e36) months, we recorded 4 deaths and 4 major amputations. Mean predicted overall survival and amputationfree survival were 29.8 (95% confidence interval [CI] 24.5e35.1) and 26.5 months (95% CI 21.1e31.8), respectively. Predicted primary patency was 76% at 3 years. Univariate analysis revealed significant associations only between bypass patency and limp loss (P-value ¼ 0.021). N.K. and S.L. equally contributed to this article and both qualify for first authorship. This article was presented as an oral presentation at the 66th annual congress of the European Society for Cardiovascular and Endovascular Surgery (ESCVS) being held on 11e14 May 2017, at Thessaloniki, Greece.