Profundoplasty in treatment of patients with chronic lower limb ischaemia

Gavrilenko A.V.^1,2, Al-Yousef N.N.¹, Wang Xiaochen², Mamedova N.M.¹, Ananieva M.V.¹, Li Rui²

1) Russian Research Centre of Surgery named after Academician B.V. Petrovsky,
2) First Moscow State Medical University named after I.M. Sechenov under the RF Ministry of Public Health, Moscow, Russia

Occlusion of the superficial femoral artery is a frequently encountered pathology in peripheral vascular disease. In patients with chronic lower limb ischaemia in a lesion of crural arteries the results of femoropopliteal bypass grafting are unsatisfactory, therefore, the deep femoral artery becomes the decisive collateral pathway for perfusion of the lower extremity.

Patients and methods. The study included a total of 166 patients presenting with TASC II B, C and D type lesions of the femoropopliteal segment after profundoplasty, who were subdivided into 3 groups depending on the stage of chronic lower limb ischaemia: Group 1 – 95 patients with stage II B, Group 2 – 56 patients with stage III, and Group 3 – 15 patients with stage IV.

Results. Five years after profundoplasty in Group 1 amputation was avoided in 90 patients (94.7%) in Group 2 – in 47 patients (83.9%), where p=0.028. During 14 months in Group 3 due to unsatisfactory distal bed 15 patients (100%) were subjected to amputation of the operated lower limb at various levels. The binary logistic regression analysis of the diameter of the deep femoral artery (p=0.045, OR=0.139) and the state of the distal arterial bed (p=0.02, OR=9.341) demonstrated that the diameter of the artery directly influenced the outcome of profundoplasty within up to 5 years.

Conclusion. Profundoplasty is an effective operation from the point of view of clinical and haemodynamic outcomes for patients presenting with occlusion of the superficial femoral artery and stenosis of the deep femoral artery with stage IIB and III chronic lower limb ischaemia. The diameter of the deep femoral artery and the condition of the arterial bed are the factors influencing the results of profundoplasty within up to 5 years.

KEY WORDS: atherosclerosis, profundoplasty, remote results, chronic lower limb ischaemia.

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