The value of percutaneous transluminal angioplasty of the profunda femoris artery in threatened limb loss and intermittent claudication

Abstract

Percutaneous transluminal angioplasty (PTA) has been performed on 29 profunda femoris artery stenoses in 26 limbs of 25 patients. Seventy per cent of the 27 atheromatous stenoses involved the origin or proximal 4 cm of the profunda. One patient had two strictures of a common femoral-profunda femoris vein graft. All had total superficial femoral or femoropopliteal occlusion (median length 29.5 cm, range 4-47 cm). The 13 patients presenting with threatened limb loss were significantly older than the remainder, who had disabling intermittent claudication (P = 0.03), and had twice the incidence of diabetes mellitus. They also had significantly fewer calf vessels patent compared with the claudicants (P = 0.008). The approaches used for profunda PTA included ipsilateral antegrade common femoral (19), ipsilateral retrograde profunda (3), cross-over technique (2), antegrade profunda (1) and brachial cutdown (1). Profunda PTA was technically successful at 26 sites (89.7%), partially successful at one, and failed at two. Concomitant PTA was successful at eight of 10 sites in eight patients. Complications requiring surgery occurred in two (7.7%). The median follow up was 17.5 months (range 1-62 months). Of the 12 limb salvage patients who underwent a technically successful profunda PTA, six required no further intervention, three subsequently underwent bypass grafting and three had an inevitable amputation, the level of amputation having been lowered in one of the patients. Nine claudicants improved symptomatically after technically successful profunda PTA; three underwent an operative procedure. Eight (61.5%) of the limb salvage group have now died, compared with two (15.4%) of the claudicants. Profunda femoris PTA is an effective alternative to profundaplasty in patients with femoropopliteal occlusive disease and may obviate the need for bypass surgery or amputation.