Follow-Up Studies and Conclusions

Abstract

Most procedures for lower-limb ischemia involve the iliosuperficial femoral axis. However, in a small but significant number of patients who have often undergone one or more reconstructive procedures, an alternative approach is required. The deep femoral artery (DFA) can be an ideal relatively disease-free site for anastomosis in the management of these difficult patients. In proximal procedures the DFA can provide sufficient runoff to maintain patency providing it has a well-developed collateral network and a patent popliteal artery (PA) with at least one good crural artery. Under these conditions ischemic lesions will heal and claudication can be completely relieved. In distal bypasses a healthy DFA can offer an alternative source of inflow. This is particularly useful in two circumstances: when the groin is heavily scarred by previous operations or is infected, and when a more distal site is required for a venous femorodistal bypass and only a short amount of vein is available. Finally, as described in detail by van Dongen (Chap. 9), profundaplasty can be a precious limb-saving operation in carefully selected patients.