Profundoplasty and balloon angioplasty of deep femoral artery in patients with atherosclerotic lesion of lower limb arteries (literature review)

• Gavrilenko A.V.
• Kavteladze Z.A.
• Sarkhanidze Ya.M.
• Magomedova G.F.

Abstract

Atherosclerosis of the lower extremities arteries accounts for 20% of the pathology of the cardiovascular system. The spread of the pathological process, high rates of disability, amputations, and mortality are characteristic of this pathology. In patients with lower limb ischemia, the state of the deep femoral artery performs a significant role. With femoral-popliteal occlusion, the viability of the limb depends entirely on the condition of the deep femoral artery. The elimination of stenotic changes in this arterial pool more frequently envisages open reconstructions, however, the correction of the inflow and outflow pathways is often carried out by the endovascular method. Proponents of open surgery note satisfactory long-term clinical results, while balloon angioplasty is becoming a less invasive method, accompanied by a low incidence of postoperative complications in persons with a high surgical risk, both in the presence of intermittent claudication and in the case of critical ischemia.

Keywords:deep femoral artery; profundoplasty; balloon angioplasty; drug-eluting balloon angioplasty

References

1.  Rowe V.L., Lee W., Weaver F.A., Etzioni D. Patterns of treatment for peripheral arterial disease in the United States: 1996– 2005. Journal of Vascular Surgery. 2009; 49 (4): 910–917. DOI: https://doi.org/10.1016/10.1016/j.jvs.2008.11.054

2. Nacional’nye rekomendatsii po diagnostike i lecheniyu zabolevaniy arteriy nizhnikh konechnostey. M. 2019; 89. (in Russian)

3. Pokrovskij A.V., Dan V.N., Chupin A.V. Hirurgicheskoe lechenie bol’nyh s kriticheskoj ishemiej nizhnih konechnostej. V kn.: Kriticheskaja ishemija. Itogi XX veka. Materialy III Mezhdunarodnogo kongressa severnyh stran i regionov. Petrozavodsk–Parizh. 1999; 120. (in Russian).

4. Tzouma G., Kopanakis N.A., Tsakotos G., et al. Anatomic Variations of the Deep Femoral Artery and Its Branches: Clinical Implications on Anterolateral Thigh Harvesting. Cureus. 2020; 12 (4): e7867. DOI: https://doi.org/10.1016/10.7759/cureus.7867

5. Choy K.W., Kogilavani S., Norshalizah M., et al. Topographical anatomy of the profunda femoris artery and the femoral nerve: Normal and abnormal relationships. Clinical Therapeutics. 2013; 164 (1): 17–19. DOI: https://doi.org/10.1016/10.7417/T.2013.1504

6. Mamatha H., D’Souza A.S., Sylvan A., et al. A cadaveric study on the variations in the origin, course and branching pattern of the profunda femoris artery. International journal of Current Research and Review. 2012; 4 (19): 137–145.

7. Billig D.M., Callow A.D., Deterling R.A. Surgical considerations in the management of lesions of the profunda femoris artery. American Journal of Surgery. 1970; 119 (4): 392–396. DOI: https://doi.org/10.1016/10.1016/0002-9610(70)90139-X

8. Tomaszewski K.A., Henry B.M., Vikse J., et al. Variations in the origin of the deep femoral artery: a meta-analysis. Clinical Anatomy. 2017; 30 (1): 106–113. DOI: https://doi.org/10.1016/10.1002/ca.22691

9. Peera S.A., Sugavasi R. Original research article morphological study of branches of femoral artery in the femoral triangle – A human cadaveric study. International Journal of Health Sciences & Research. 2013; 3 (12): 14–19.

10. Prendiville E.J., Burke P.E., Colgan M.P., et al. The profunda femoris: A durable outflow vessel in aortofemoral surgery. Journal of Vascular Surgery. 1992; 16 (1): 23–29. DOI: https://doi.org/10.1016/0741-5214(92)90413-3

11. Dixit D., Kubavat D.M., Rathod S.P., et al. A study of variations in the origin of profunda femoris artery and its circumflex branches. International Journal of Biological & Medical Research. 2011; 2 (4): 1084–1089.

12. Martin P., Frawley J.E., Barabas A.P. On the surgery of atherosclerosis of the profunda femoris artery. Surgery. 1972; 71: 182–189.

13. Cotton L.T., Roberts V.C. Extended deep femoral angioplasty: an alternative to femoropopliteal bypass. British Journal of Surgery. 1975; 62 (5): 340–343. DOI: https://doi.org/10.1002/bjs.1800620503

14. Gavrilenko A.V., Kotov A.Je., Lepshokov M.K. Rol’ plastiki glubokoj arterii bedra v lechenii hronicheskoj kriticheskoj ishemii nizhnih konechnostej. Annaly hirurgii. 2017; 22 (6): 321–328. DOI: https://doi.org/10.18821/1560-9502-2017-22-6-321-328 (in Russian)

15. Feldhaus R.J., Sterpetti A.V., Schultz R.D. Eversion endarterectomy of the superficial femoral artery and end-to-side anastomosis to the deep femoral artery. An alternative to extended profundoplasty. American Journal of Surgery. 1985; 150 (6): 748–752. DOI: https://doi.org/10.1016/0002-9610(85)90422-2

16. Kalman P.G., Hosang M., Johnston K.W. The current role for femorofemoral bypass. Journal of Vascular Surgery. 1987; 6 (1): 71–76. DOI: https://doi.org/10.1067/mva.1987.avs0060071

17. Pearce W.F., Kempczinski R.F. Extended autogenous profundoplasty and aortofemoral grafting: an alternative to synchronous distal bypass. Journal of Vascular Surgery. 1984; 1 (3): 455–458. DOI: https://doi.org/10.1016/0741-5214(84)90085-5

18. Stern J.R., Bernhard V.M. In the Patient with Profunda Artery Disease, Is Open Revascularization Superior to Endovascular Repair for Improving Rest Pain? In: Skelly C., Milner R. (eds.). Difficult Decisions in Vascular Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. 2017. DOI: https://doi.org/10.1007/978-3-319-33293-2_16

19. Dotter C.T., Judkins M.P. Transluminal Treatment of Arteriosclerotic Obstruction: Description of a New Technic and a Preliminary Report of Its Application. Radiology. 172 (3): 904–920. DOI: https://doi.org/10.1148/172.3.904

20. Werk M., Langner S., Reinkensmeier B. Inhibition of restenosis in femoropopliteal arteries. Paclitaxel-coated versus uncoated balloon: femoral paclitaxel randomized pilot trial. Circulation. 2008; 118 (13): 1358–1365. DOI: doi: 10.1161/CIRCULATIONAHA.107.735985

21. Kavteladze Z.A., Bylov K.V., Drozdov S.A. Angioplastika i stentirovanie poverhnostnoy bedrennoy arterii. International Journal of Interventional Cardioangiology. 2011; 24: 52–53. (in Russian)

22. Schillinger M., Sabeti S., Loewe C. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. New England Journal of Medicine. 2006; 354 (18): 1879–1888. DOI: https://doi.org/10.1056/NEJMoa051303

23. Pastromas G., Katsanos K., Krokidis M. Emerging Stent and Balloon Technologies in the Femoropopliteal Arteries. The Scientific World Journal. 2014; 2014 (695402): 1–6. DOI: https://doi.org/10.1155/2014/695402

24. Dick P., Sabeti S., Mlekusch W. Conventional balloon angioplasty versus peripheral cutting balloon angioplasty for treatment of femoropopliteal artery in-stent restenosis: initial experience. Radiology. 2008; 248 (1): 297–302. DOI: https://doi.org/10.1148/radiol.2481071159

25. Dake M.D., Ansel G.M., Jaff M.R. Sustained safety and effectiveness of paclitaxel-eluting stents for femoropopliteal lesions: 2-year follow-up from the Zilver PTX randomized and single-arm clinical studies. American College of Cardiology. 2013; 61 (24): 2417–2427. DOI: https://doi.org/10.1016/j.jacc.2013.03.034

26. Lammer J., Bosiers M., Zeller T. First clinical trial of nitinol self-expanding everolimus-eluting stent implantation for peripheral arterial occlusive disease. Journal of Vascular Surgery. 2011; 54 (2): 394–401. DOI: https://doi.org/10.1016/j.jvs.2011.01.047

27. Krokidis M., Spiliopoulos S., Katsanos K. Peripheral applications of drug-coated balloons: past, present and future. CardioVascular and Interventional Radiology. 2013; 36 (2): 281–291. DOI: https://doi.org/10.1007/s00270-012-0467-0

28. Tepe G. The THUNDER Trial: 5-Year Results of a Trial Investigating DEB Vs. POBA, Learning International Networks Consortium. Germany: Leipzig. 2012.

29. Taurino M., Persiani F., Ficarelli R. The Role of the Profundoplasty in the Modern Management of Patient with Peripheral Vascular Disease. Annals of Vascular Surgery. 2017; 45: 16–21. DOI: https://doi.org/10.1016/j.avsg.2017.05.018

30. Shu J., Santulli G. Update on peripheral artery disease: Epidemiology and evidence-based facts. Atherosclerosis. 2018; 275: 379–381. DOI: https://doi.org/10.1016/j.atherosclerosis.2018.05.033

31. Manenti A., Roncati L., Manco G. Pathophysiology of the profunda femoris artery in chronic lower limb ischemia. Annals of Vascular Surgery. 2021; 77: e2–e3. DOI: https://doi.org/10.1016/j.avsg.2021.05.028

32. Qato K., Nguyen N., Bouris Vasilieos Outcomes of Endovascular Management of Isolated Profunda Femoris Artery Occlusive Disease. Annals of Vascular Surgery. 2021; 72: 244–252. DOI: https://doi.org/10.1016/j.avsg.2020.08.138

33. Georgakarakos E., Tasopoulou K.-M., Koutsoumpelis A., Georgiadis G.S. The Importance of Profunda Femoris Artery Justifies Further the Endovascular Approach in Critical Limb Ischemia. Annals of Vascular Surgery. 2018; 49: 318–319. DOI: https://doi.org/10.1016/j.avsg.2017.11.048