The role of the profunda femoris in aorto-iliac surgery

Reconstructive Surgery for Combined Aortofemoral and Infrafemoral Occlusion

In reconstructive surgery for combined aortoiliac and infrafemoral occlu sion, there are many reports that only proximal repair with profunda plasty has resulted in a symptomatic improvement.1-5 However, the 5-year patency and the limb salvage rate were low, and some surgeons have reported that many patients had remained without symptomatic improvement. 6-11

This study was made to assess the indication for subsequent repair in peripheral combined lesions and report the prognosis in the reconstructive surgery for tandem lesions.

Some aspects of ultrasound in the diagnosis and assessment of aortoiliac disease

The presence and severity of aortoiliac atherosclerosis were assessed in 60 normal limbs and 54 limbs with peripheral vascular disease by means of arteriography, clinical examination and ultrasound analysis. The latter involved common femoral sonogram analysis with particular measurement of the pulsatility index, a study of transit time ratios and measurement of the half recovery time during reactive hyperemia. The transit time data were of limited value and only capable of diagnosing aortoiliac disease when complete occlusion was present. The pulsatility index and half recovery time were more sensitive indicators of aortoiliac disease, and both were superior to clinical examination alone. Their values became increasingly abnormal with increasing severity of disease, and both reverted to normal after successful aortoiliac surgery. When it was possible to directly inspect the aortoiliac segment at operation, the half recovery time accurately predicted the presence or absence of aortoiliac disease in every case, and its use as a reliable screen for aortoiliac disease is particularly recommended.

A comparison of proximal with distal arterial reconstruction in the treatment of advanced lower limb ischaemia

Elective arterial surgery for lower limb ischaemia due to chronic occlusive disease has been performed in 212 patients over a five-year period. Of this group, 93 patients were treated for limb-threatening ischaemia. The remainder were treated for intermittent claudication. The clinical and haemodynamic responses to surgery are analysed in this series of 93 patients. The results of proximal reconstruction, in terms of a living patient with patent graft and functional limb, were significantly better (75%) at one year than in patients undergoing distal segment reconstruction (45%). Successful aortoiliac surgery was associated with a mean increase in the ankle systolic pressure index of 0.36, comparied with 0.46 in the distal reconstruction group.