Autogenous Profundaplasty

Abstract

The records of 281 patients undergoing aortic grafting to 522 femoral arteries over 18 yr were reviewed. Graft limb occlusion to 71 femoral arteries in 54 patients required subsequent secondary repair. Occlusive disease of the profunda femoris artery was identified as the primary cause of thrombosis. Repair consisted of profunda femoris angioplasty, and transfemoral retrograde graft thrombectomy was possible in all but 3 instances which were managed by cross-over femoral-femoral bypass. Laparotomy and abdominal graft replacement was not necessary. The 30 day operative survival and graft patency were 100%. Key factors that influenced late graft patency were the method of profundaplasty and the association of diabetes mellitus. When autogenous profundaplasty (on-lay arterial patches, saphenous vein or limited endarterectomy) was employed, the overall patency combining diabetics and non-diabetics was 2.5 times greater than when profundaplasty was performed with an on-lay Dacron patch. If diabetics were separated from nondiabetics in the autogenous angioplasty group, the 36 mo. patency for non-diabetics was 85% and 0% for diabetics. Autogenous profundaplasty has the advantage of long-term patency and diabetics are relatively poor candidates for secondary arterial repair of an occluded aortofemoral bypass graft.