Deep Femoral Artery Revascularization

  • M. P. Merlini


Following the description of the surgical approach of the deep femoral artery (DFA), this chapter and the subsequent ones are devoted to the surgical techniques and their specific indications. The current chapter deals with revascularization of the DFA. In this term, one must include all the techniques which improve blood flow at the ostium of this artery (Schwilden and van Dongen 1987; Fig. 1). They are not techniques concerning the DFA itself: the trunk of this artery and even the ostium are not affected. Revas-cularization improves proximal flow. One must therefore differentiate between revascularization and profundaplasty (Chap. 9).


Limb Salvage Superficial Femoral Artery Common Femoral Artery External Iliac Artery Proximal Anastomosis 
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  1. Ascer E, Veith FJ, Gupta SK, Scher LA, Samson RH, White-Flores SA, Sprayregen S (1985) Comparison of axillounifemoral and axillobifemoral bypass operations. Surgery 97: 169–175PubMedGoogle Scholar
  2. Bagi P, Sillesen H, Hansen HJB (1988) Quantitative Doppler ultrasound evaluation of occlusive arterial disease in the lower limb. Eur J Vase Surg 2: 409–415CrossRefGoogle Scholar
  3. Bagi P, Sillesen H, Bitsch K, Hansen HJB (1990) Doppler waveform analysis in evaluation of occlusive arterial disease in the lower limb: comparison with distal blood pressure measurement and arteriography. Eur J Vase Surg 4: 305–311CrossRefGoogle Scholar
  4. Baker JD (1990) Hemodynamic assessment of aortoiliac segment. Surg Clin North Am 70: 31–40PubMedGoogle Scholar
  5. Barringer M, Poole GV, Shircliffe AC, Meredith JW, Hightower F, Plonk GW (1983) The diagnosis of aortoiliac disease. A noninvasive femoral cuff tech¬nique. Ann Surg 197: 204–209PubMedCrossRefGoogle Scholar
  6. Becker GJ (1991) Intravascular stents. General principles and status of lower-extremity arterial applications. Circulation 83 [Suppl I]: 1–122 — 1–136Google Scholar
  7. Bernhard VM, Ray LI, Militello JP (1976) The role of angioplasty of the profunda femoris artery in revascularization of the ischemic limb. Surg Gynecol Obstet 142: 840–844PubMedGoogle Scholar
  8. Bettmann MA (1992) Principles of angiography. In: Loscalzo J, Creager MA, Dzau VJ (eds) Vascular medicine. Little and Brown, Boston, pp 483–507Google Scholar
  9. Blaisdell FW (1990) Axillofemoral and axillopopliteal grafts. In: Bergan JJ, Yao JST (eds) Techniques in vascular surgery. Saunders, Philadelphia, pp 339–348Google Scholar
  10. Blaisdell FW, DeMattei GA, Gauder PJ (1961) Extraperitoneal aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis. Am J Surg 102: 583–585PubMedCrossRefGoogle Scholar
  11. Branchereau A, Magnan PE, Moracchini P, Espinoza H, Mathieu JP (1992) Use of descending thoracic aorta for lower limb revascularization. Eur J Vase Surg 6: 255–262CrossRefGoogle Scholar
  12. Calligaro KD, Ascer E, Veith FJ, Gupta SK, Wengerter KR, Franco CD, Bakal CW, Sprayregen S (1990) Unsuspected inflow disease in candidates for axillofemoral bypass operations: a prospective study. J Vase Surg 11: 832–837Google Scholar
  13. Carpenter JP, Owen RS, Baum RA, Cope C, Barker CF, Berkowitz HD, Golden MA, Perloff LJ (1992) Magnetic resonance angiography of peripheral runoff vessels. J Vase Surg 16: 807–815CrossRefGoogle Scholar
  14. Cossman DV, Ellison JE, Wagner WH, Carroll RM, Treiman RL, Foran RF, Levin PM, Cohen JL (1989) Comparison of contrast arteriography to arterial mapping with color-flow duplex imaging in the lower extremities. J Vase Surg 10: 522–529Google Scholar
  15. Criado E, Johnson G Jr, Burnham SJ, Buehrer J, Keagy BA (1992) Descending thoracic aorta-to-iliofemoral artery bypass as an alternative to aortoiliac recon¬struction. J Vase Surg 15: 550–557CrossRefGoogle Scholar
  16. Darling RC III, Leather RP, Chang BB, Lloyd WE, Shah DM (1993) Is iliac artery a suitable inflow conduit for iliofemoral occlusive disease: an analysis of 514 aortoiliac reconstructions. J Vase Surg 17: 15–22CrossRefGoogle Scholar
  17. Dick LS, Brief DK, Alpert J, Brener BJ, Goldenkranz R, Parsonnet V (1980) A 12-year experience with femorofemoral crossover grafts. Arch Surg 115: 1359–1365PubMedGoogle Scholar
  18. Dietzek AM, Goldsmith J, Veith FJ, Sanchez LA, Gupta SK, Wengerter KR (1990) Interruption of critical aortoiliac collateral circulation during nonvas¬cular operations: a cause of acute limb-threatening ischemia. J Vase Surg 12: 645–653CrossRefGoogle Scholar
  19. Dinis da Gama A (1988) The fate of donor artery in extraanatomic revasculariz-ation. J Vase Surg 8: 106–111Google Scholar
  20. Dotter CT, Judkins MP (1964) Transluminal treatment of arteriosclerotic obstruction: description of a new technic and a preliminary report of its application. Circulation 30: 654–670PubMedGoogle Scholar
  21. Edwards WH, Jenkins JM, Muhlherin JL, Martin RS, Edwards WH Jr (1989) Extended profundoplasty to minimize pelvic and distal tissue loss. Ann Surg 211: 694–702CrossRefGoogle Scholar
  22. Ehrenfeld WK, Harris JD, Wylie EJ (1968) Vascular ‘steal’ phenomenon. An experimental study. Am J Surg 116: 192–197PubMedCrossRefGoogle Scholar
  23. Fahal AH, McDonald AM, Marston A (1989) Femorofemoral bypass in unilateraliliac artery occlusion. Br J Surg 76: 22–25PubMedCrossRefGoogle Scholar
  24. Farber MA, Hollier LH, Eubanks R, Ochsner JL, Bowen JC (1990) Femorofemoral bypass: a profile of graft failure. South Med J 83: 1437–1443PubMedCrossRefGoogle Scholar
  25. Feldhaus RJ, Sterpetti AV, Schultz RD, Peetz DJ (1985) A technique for pro¬funda femoris artery reconstruction. Ann Surg 203: 390–398CrossRefGoogle Scholar
  26. Flanigan DP, Ryan TJ, Williams LR, Schwartz JA, Gray B, Schuler JJ (1984) Aortofemoral or femoropopliteal revascularization? A prospective evaluation of the papaverine test. J Vase Surg 1: 215–223CrossRefGoogle Scholar
  27. Friedenberg MJ, Perez CA (1965) Collateral circulation in aorto-ilio-femoral occlusive disease. Am J Roentgenol 94: 145–158Google Scholar
  28. Gaylis H (1992) Interruption of critical aortoiliac circulation during nonvascular operations: a cause of acute limb-threatening ischemia. J Vase Surg 15: 256–257Google Scholar
  29. Goldstone J (1990) Management of late failures of aorto-femoral reconstructions. Acta Chir Scand Suppl 555: 149–153PubMedGoogle Scholar
  30. Guidoin R, King M, Deng X, Paris E, Douville Y (1992) Protheses arterielles en polyester. In: Kieffer E (ed) Le remplacement arteriel: principes et applications. AERCV, Paris, pp 3–51Google Scholar
  31. Gupta SK, Veith FJ, Kram HB, Wengerter KA (1990) Significance and management of inflow gradients unexpectedly generated after femorofemoral, femoropopliteal, and femoroinfrapopliteal bypass grafting. J Vase Surg 12: 278–283Google Scholar
  32. Iliopoulos JI, Pierce GE, McCroskey BL, Thomas JH, Hermreck AS (1985) Success of profundoplasty: the role of the extent of deep femoral artery disease. Am J Surg 150: 753–756 Iliopoulos JI, Hermreck AS, Thomas JH, Pierce GE (1989) Hemodynamics of the hypogastric arterial circulation. J Vase Surg 9: 637–642Google Scholar
  33. Iliopoulos JI, Pierce GE, Hermreck AS, Haller CC, Thomas JH (1990) Hemodynamics of the inferior mesenteric arterial circulation. J Vase Surg 11: 120–126Google Scholar
  34. Jausseran JM, Nazet J, Chbib A, Bergeron P, Rudondy P, Ferdani M, Courbier R (1991) Revascularisation de l’artere femorale profonde distale. J Chir 128: 26–29Google Scholar
  35. Johnston KW (1987) Peripheral arterial Doppler blood flow velocity waveform analysis. In: Kempczinski RF, Yao JST (eds) Practical noninvasive vascular diagnosis. Year Book Medical Publishers, Chicago, pp 154–177Google Scholar
  36. Johnston KW (1990) Aortoiliac reconstruction. In: Barnes RW (ed) Peripheral vascular surgery. American College of Surgeons, San Francisco, pp 7–9Google Scholar
  37. Johnston KW (1992) Factors that influence the outcome of aortoiliac and femoro-popliteal percutaneous transluminal angioplasty. Surg Clin North Am 72: 843–850PubMedGoogle Scholar
  38. Kalman PG, Hosang M, Johnston KW, Walker PM (1987a) The current role for femorofemoral bypass. J Vase Surg 6: 71–76CrossRefGoogle Scholar
  39. Kalman PG, Hosang M, Johnston KW, Walker PM (1987b) Unilateral iliac disease: the role of iliofemoral bypass. J Vase Surg 6: 139–143CrossRefGoogle Scholar
  40. Kitslaar PJEHM, Jorning PJG, Kohlen JPFM (1988) Assessment of aortoiliac stenosis by femoral artery pressure measurement and Doppler waveform analysis. Eur J Vac Surg 2: 35–40CrossRefGoogle Scholar
  41. Kohler TP, Nance DR, Cramer MM, Vandenburge N, Strandness DE Jr (1987) Duplex scanning for diagnosis of aortoiliac and femoropopliteal disease: a prospective study. Circulation 76: 1074–1080PubMedCrossRefGoogle Scholar
  42. Krahl E, Pratt GH, Rousselot LM, Ruzicka FF (1954) The collateral circulation in the arterial occlusive disease of the lower extremity. Surg Gynecol Obstet 98: 320–324Google Scholar
  43. Kram HB, Gupta SK, Veith FJ, Wengerter KR (1991) Unilateral aorto- femoral bypass: a safe and effective option for the treatment of unilateral limb- threatening ischemia. Am J Surg 162: 155–158PubMedCrossRefGoogle Scholar
  44. Krupski WC, Sumchai A, Effeney DJ, Ehrenfeld WK (1984) The importance of abdominal wall collateral blood vessels. Arch Surg 119: 854–857PubMedGoogle Scholar
  45. Lamberton AJ, Nicolaides AN, Eastcott HHG (1985) The femorofemoral graft. Arch Surg 120: 1274–1278Google Scholar
  46. Lee RE, Baird RN (1990) A haemodynamic evaluation of the femoro-femoral cross-over bypass. Eur J Vase Surg 4: 167–172CrossRefGoogle Scholar
  47. Legemate DA, Ackerstaff RGA, Eikelboom BC (1989) Duplex scanning in cerebral, abdominal and peripheral arterial disease. Eur J Vase Surg 3: 287–295CrossRefGoogle Scholar
  48. Legemate DA, Teeuwen C, Hoeneveld H, Eikelboom BC (1991) Value of duplex scanning compared with angiography and pressure measurement in the assessment of aortoiliac arterial lesions. Br J Surg 78: 1003–1008PubMedCrossRefGoogle Scholar
  49. Lo Gerfo FW, Johnson WC, Corson JD, Vollman RW, Weisel RD, Davis RC, O’Hara ET, Nasbeth DC, Mannick JA (1977) A comparison of the late patency rates of axillobilateral femoral and axillounilateral femoral grafts. Surgery 81: 33–38Google Scholar
  50. Lorentzen JE, Jørgensen L, Johansen JJ (1990) The ideal operation for unilateral iliac occlusion. Should the asymptomatic iliac artery also be reconstructed? Acta Chir Scand Suppl 555: 69–71PubMedGoogle Scholar
  51. Mahler F (1990) PTA der Beckenarterien und terminalen Aorta. In: Mahler F (ed) Katheterinterventionen in der Angiologie. Thieme, Stuttgart, pp 79–131Google Scholar
  52. McCoy DM, Sawchuk AP, Schuler JJ, Durham JR, Eldrup-Jorgensen J, Schwarcz TH, Meyer JP, Flanigan P (1989) The role of isolated profundaplasty for the treatment of rest pain. Arch Surg 124: 441 - 444PubMedGoogle Scholar
  53. Melliere D, Labastie J, Becquemin JP, Kassab M, Paris E (1990) Proximal anastomosis in aortobifemoral bypass: end-to-end or end-to-side ? J Cardiovasc Surg 31: 77–80Google Scholar
  54. Miksic K, Novak B (1986) Profunda femoris revascularization in limb salvage. J Cardiovasc Surg 27: 544–552Google Scholar
  55. Naylor AR, Ah-See AK, Engeset J (1990) Aortoiliac endarterectomy: an 11-year review. Br J Surg 77: 190–193PubMedCrossRefGoogle Scholar
  56. Nunez AA, Veith FJ, Collier P, Ascer E, White-Flores SA, Gupta SK (1988) Direct approaches to the distal portions of the deep femoral artery for limb salvage bypasses. J Vase Surg 8: 576–581Google Scholar
  57. Ouriel K, De Weese JA, Ricotta JJ, Green RM (1987) Revascularization of the distal profunda femoris artery in the reconstructive treatment of aortoiliac occlusive disease. J Vase Surg 6: 217–220Google Scholar
  58. Paes EHJ, Hamann H (1989) Die Profundarevaskularisation: eine vergessene Alternative zur Mehretagenrekonstruktion. Vasa 18: 287–290PubMedGoogle Scholar
  59. Palmaz JC, Garcia OJ, Shatz RA, Rees CR, Roeren T, Richter GM, Noeldge G, Gardiner GA, Becker GJ, Walker C, Stagg J, Katzen BT, Dake MD, Paolini RM, McLean GK, Lammer J, Schwarten DE, Tio FO, Root HD, Rogers W (1990) Placement of balloon-expandable intraluminal stents in iliac arteries: first 171 procedures. Radiology 174: 969–975PubMedGoogle Scholar
  60. Perler BA, Burdick JF, Williams GM (1991) Femoro-femoral or ilio-femoral bypass for unilateral inflow reconstruction? Am J Surg 161: 426–430PubMedCrossRefGoogle Scholar
  61. Persson AV, Gibbons G, Griffey S (1981) Noninvasive evaluation of the aortoiliac segment. J Cardiovasc Surg 22: 539–542Google Scholar
  62. Piotrowski JJ, Pearce WH, Jones DN, Whitehill T, Bell R, Patt, Rutherford RB (1988) Aortobifemoral bypass: the operation of choice for unilateral iliac oc¬clusion? J Vase Surg 8: 211 –218Google Scholar
  63. Plecha FR, Plecha FM (1984) Femorofemoral bypass grafts: ten-year experience. J Vase Surg 1: 555–561Google Scholar
  64. Rollins DL, Towne JB, Bernhard VM, Baum PL (1985) Isolated profundaplasty for limb salvage. J Vase Surg 2: 585–590Google Scholar
  65. Rutherford RB, Patt A, Pearce WH (1987) Extra-anatomic bypass: a closer review. J Vase Surg 6: 437–446Google Scholar
  66. Sawchuk AP, Flanigan P, Tober JC, Eton D, Schwarcz TH, Eldrup-Jorgensen J, Meyer JP, Durham JR, Schuler JJ (1990) A rapid, accurate, noninvasive technique for diagnosing critical and subcritical stenoses in aortoiliac arteries. J Vase Surg 12: 158–167Google Scholar
  67. Schwilden ED, van Dongen RJAM (1987) Eingriffe an der Arteria profunda femoris. In: Heberer G, van Dongen RJAM (eds) Gefasschirurgie. Springer, Berlin Heidelberg New York, pp 457–473Google Scholar
  68. Shin CS, Chaudhry AG (1979) The hemodynamics of extra-anatomic bypass grafts. Surg Gynecol Obstet 148: 567–570PubMedGoogle Scholar
  69. Stevenson JK, Sauvage LR, Harkins HN (1961) A bypass homograft from thoracic aorta to femoral arteries for occlusive vascular disease. Case report. Am Surg 27: 632–637Google Scholar
  70. Sumner DS (1989) Essential hemodynamic principles. In: Rutherford RB (ed) Vascular surgery. Saunders, Philadelphia, pp 18–41Google Scholar
  71. Szilagyi DE, Elliot JP, Smith RF, Reddy DJ, McPharlin M (1986) A thirty-year survey of the reconstructive surgical treatment of aortoiliac occlusive disease. J Vase Surg 3: 421–436Google Scholar
  72. Tegtmeyer CJ, Hartwell GD, Selby JB, Robertson R Jr, Kron IL, Tribble CG (1991) Results and complications of angioplasty in aortoiliac disease. Cir-culation 83 [Suppl I]: 1–53–1–60Google Scholar
  73. Towne JB, Rollins DL (1986) Profundaplasty: its role in limb salvage. Surg Clin North Am 66: 403–414PubMedGoogle Scholar
  74. van der Heijden FHWM, Legemate DA, van Leeuwen MS, Mali WPTM, Eikelboom BC (1993) Value of duplex scanning in the selection of patients for percutaneous transluminal angioplasty. Eur J Vase Surg 7: 71–76CrossRefGoogle Scholar
  75. Vashisht R, Ellis MR, Skidmore C, Blair SD, Greenhalgh RM, O’Malley MK (1992) Colour-coded duplex ultrasonography in the selection of patients for endovascular surgery. Br J Surg 79: 1030–1031PubMedCrossRefGoogle Scholar
  76. Veith FJ, Gupta SK, Wengerter KR, Rivers SP, Bakal CW (1991) Impact of nonoperative therapy on the clinical management of peripheral arterial disease. Circulation 83 [Suppl I]: I-137-I-142Google Scholar
  77. Ward RE, Holcroft JW, Conti S, Blaisdell FW (1983) New concepts in the use of axillofemoral bypass grafts. Arch Surg 118: 573 – 576PubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1994

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  • M. P. Merlini

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