Tratamiento quirúrgico de la arteria femoral profunda en su tercio distal con interposición de un collarete venoso de Miller

Aim. To determine if surgical treatment of the distal portion of deep femoral artery (DFA) is a valid technique for limb salvage in patients with critical limb ischemia. Patients and methods. A retrospective study analyzing admitted patients with critical limb ischemia was performed. These patients underwent a DFA revascularization with interposition of a Miller cuff, excluding those with extensive gangrene. Thirty cases were found, 26 male and 4 women with a mean age of 72 ± 9 years. The admission diagnosis was rest pain in 22 cases (73.3%), and trophyc lesions in 8 cases (26.6%). The procedures performed were 3 ilio-femoral bypasses, 3 femoral sector reconstructions, 17 femoro-femoral bypasses, 4 axilo-femoral bypasses, 1 extension from a previous ilio-femoral bypass and 2 extensions from previous aortobifemoral bypasses. Results. The mean follow up time was 18 months (15-60). Postoperative ABI increase was 0.25 ± 0.1, and postoperative mortality was none, with 9 deaths none related with the surgical procedure, 2 heart related, 4 neoplasic and 3 non determined. The primary patency rate was 86.7% with a secondary patency rate of 93.3%. No graft infections were detected and the limb salvage rate was 93.3%. Two amputations were performed, one due to a graft failure and one due to gangrene progression. Conclusions. The revascularization of the distal portion of the DFA in selected patients is a valid technique for limb salvage, achieving an excellent technical success with few complications and a good limb salvage rate. [ANGIOLOGÍA 2009; 61: 77-82]