Indications for Profundaplasty

Abstract

The indications for lower extremity revascularization through the deep femoral artery (DFA) are based on well-established anatomical and physiologic principles. The DFA serves a dual purpose in the economy of lower extremity circulation (Martin and Jamieson 1974; Bernhard et al. 1976). Primarily, it is the main arterial conduit to supply blood to the muscles and other structures of the thigh. Its secondary purpose, as the major collateral for the obstructed superficial femoral artery (SFA), derives from its axial location parallel to the SFA and its length, which can bridge the distance between the common femoral (CFA) and the popliteal vessels. The numerous connections between the distal perforating branches and the genicular vessels establish a rich collateral network to the popliteal artery (PA). When the PA is also occluded, the genicular branches exploit their connections through the recurrent branches of the tibial arteries to reestablish blood flow to the calf. Proximal DFA branches, primarily the medial and lateral circumflex vessels, provide collateral continuity with the pelvis through the cruciate anastomosis to the hypogastric (internal iliac) arteries as well as to the deep epigastric and circumflex iliac vessels in the lower abdominal wall and flank (Martin and Jamieson 1974).