Utilization of the distal profunda femoris artery in redo arterial bypass procedures

ABSTRACT

In the present study, an experience with 12 cases of difficult redo vascular reconstruction was described, where the distal profunda femoris artery was utilized. They were nine males and three females with a mean age of 55 years. The indication for vascular reconstruction was limb-threatening ischemia in all cases [rest pain in 42% of the cases, tissue necrosis and gangrene in 58% of the cases]. The primary reason for using the distal profunda was to avoid dense groin scarring. The number of prior groin operations ranged from two to four procedures per patient. An additional groin scarring was present due to radiation therapy in one patient, infected sinus and a local rotational flap procedure in another patient. The distal profunda was used as a donor vessel to originate a distal bypass in eight cases. In two cases, the distal profunda was used as a recipient vessel for a proximal bypass graft. In the remaining two cases, it was used both as a recipient vessel for an ilio-profunda bypass and sequentially as a donor vessel for a profunda-popliteal bypass graft. An anterolateral approach for distal profunda exposure was used in two cases and an anteromedial approach was used in two cases. The study concluded that the utilization of the distal profunda femoris artery in vascular reconstruction is particularly useful in cases of reoperative surgery when the common femoral moral artery is embedded in scar tissue or inflammatory reaction. Furthermore, the distal profunda can serve as a proximal anastomotic site for distal bypass grafts when the available autogenous vein is of a limited length