The role of the profunda femoris in aorto-iliac surgery

Abstract

The results of aorto-iliac surgery in 90 ischaemic limbs (68 patients) have been reviewed. The mean follow-up period was 18 months (rang 6 monts to 3.5 years). In 48 limbs the disease was confined to the aorto-iliac segment (group 1), while in 42 limbs severe occlusive changes were present in both the aorto-iliac and superficial femoral segments (group 2). In group intermittent claudication was obolised or substanitally improved in 86 per cent. Rest pain was relieved in all cases. Lumbar sympathectomy was with out obvious additional benefit in either group. Pedal pules were restored in all except 3 limbs. A highly significant (P <0.001) increase in the ankle systolic pressure (ASP) index occurred after surgery and normal values were restored both in claudicants and in those with rest pain. This response was maintained through out the follow-up period. Claudication was effectively relived in 38 per cent of cases in group 2 following aortoprofunda reconstruction. Rest pain was abolished in 83 per cent of cases, the remainder requrining a major amputation. Lumbar sympathectomy failed to produce any additional benefit among either claudicants or those with rest pain. Pedal pulses were restored in only 2 limbs. Among claudicants the ASP index was uncharged, and although a significatn (P <0.001) increase occurred in the rest pain group, the index remained within the ischaemic range. There was little variation in the value of the ASP index throughout the follow-up period in either group. The difference between the ASP response to surgery in patients with aorto-iliac disese alone and those with dual occlusion was highly significant (P <0.001). The present results suggest that among claudicants revascularization of the profunda alone may be followed by a limited clinical and hoemodynamic response. However, as a limb salvage procedure, aortoprofunda reconstruction can be recommended with confidence. When both the superficial and deep femoral vessels are patent, on excellent response is to be expected after aorto-iliac surgery in claudicants and patients with rest pain alike.