Limb saving by profundoplasty in patients with no distal runoff

Abstract

Background With the great advancement of endovascular intervention in the management of both chronic and acute peripheral vascular disease, the need for open surgical intervention has markedly decreased over the past decade; however, in certain cases, a simple surgical intervention remains the only hope for limb saving. In this study, the authors presented a review for the effect of one of the oldest surgical vascular procedures, which is ‘profundoplasty’ and the authors focused on its role and outcome in cases presented with threatened limb with no distal runoff to the foot. Patients and methods This is a retrospective study conducted on 18 cases presented with 20 threatened limbs with no distal runoff and managed with either isolated profundoplasty or combined with other procedures in the period between May 2016 and May 2018 at the Vascular Surgery Department of Kasr Al Aini with the limb salvage as the end point. Results The study included 18 male patients with mean age of 50 years presented with 20 threatened limbs: 10 patients presented with critical limb ischemia classified according to Rutherford classification between class 4 and 6, and eight patients with 10 delayed acute limb ischemia category IIb (two patients presented with bilateral lower limb affection). Technical success was 100%; two cases of critical limb ischemia ended up with unilateral below-knee amputation, with limb salvage rate of 90%. Conclusion Profundoplasty remains a very effective procedure in the management of lower limb ischemia either acute or chronic, especially when other options cannot be performed and the case seems to be hopeless.