Anatomical Predictors of Clinical Improvement After Profundoplasty in Patients with an Occluded Superficial Artery: A Pilot Study

Background: To date, it remains unclear which patients with occluded superficial femoral arteries (SFA) benefit from profundoplasty. Our hypothesis is that certain anatomic factors regarding the femoral bifurcation, e.g., the degree of stenosis of the common or deep femoral artery (CFA or DFA), length of stenosis of the DFA, or number of collaterals, can predict clinical success. Methods: An analysis pilot study was conducted to determine if the aforementioned anatomical features can predict clinical improvement and the need for major amputation following profundoplasty in patients with an occluded SFA. Results: Forty-nine patients were included in the analysis, most of whom were male (67.3%). The median stenosis of the CFA was 70%, and the mean stenosis of the DFA was 61%. During the follow-up period (mean 14.7 months), six major amputations were performed and 10 femoropopliteal or -crural bypasses were performed. The degree of DFA stenosis was a protective factor for major amputation (p = 0.04). The degree of DFA stenosis and the runoff score were associated with improvement of the Rutherford classification. However, in the multivariate analyses, none of the parameters were associated with the risk of amputation, need for peripheral bypass, or clinical improvement. Conclusions: Although this is a small and retrospective study, it suggests that a higher degree of DFA stenosis may be associated with a greater benefit from profundoplasty and a lower risk of major amputation. Further validation with larger patient populations and longer follow-up periods are necessary.