Patient selection for isolated profundaplasty: Arteriographic correlates of operative results

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Twenty-seven patients undergoing isolated profundaplasty were reviewed to determine the efficacy of the procedure and to define the criteria for patient selection. Successful results defined by relief of symptoms, healing of the ulceration, or minor forefoot amputation were achieved in 12 patients (44.4 per cent). Improved limbs uniformly demonstrated increased ankle blood pressure determined by Doppler ultrasound. One patient (3.7 per cent) died and eight (29.6 per cent) experienced significant complications including hemorrhage, wound infection, profunda thrombosis, patch graft infection, and chronic leg edema. Nine patients (33 per cent) ultimately required major amputation. Although a variety of preoperative clinical variables were assessed, arteriography provided the only reliable prognostic correlates. Findings associated with successful profundaplasty included (1) severe stenosis of the profunda orifice, (2) minimal occlusive disease of the distal profunda, (3) disease-free profunda collaterals, (4) reconstitution of patent superficial femoral or popliteal artery, and (5) good popliteal outflow. These findings were present in nine patients, all of whom underwent successful profundaplasty. Variance from this optimal arteriographic pattern was associated with less frequent success. The association of profunda orifice stenosis with distal disease in either the profunda collateral, popliteal, or popliteal outflow vessels resulted in success in 3 of 11 patients. The findings always associated with failure included minimal disease of the profunda orifice and marked distal profunda disease. An understanding of the collateral system provided by the profunda and its arteriographic evaluation can identify patients who will benefit from isolated profundaplasty.