Percutaneous profunda femoris artery revascularization to prevent hip disarticulation: case series and review of the literature

BackgroundLittle is known about the role of percutaneous revascularization of the profunda femoral artery (PFA) in patients with amputation stump ischemia who are at risk of hip disarticulation.MethodsWe identified 4 patients who were treated for persistent amputation stump ischemia by PFA percutaneous revascularization over a 3-year period. All 4 patients had significant cardiopulmonary comorbidities and 2 patients had at least 3 previous groin surgeries. The short- and long-term outcomes of the patients were evaluated with regard to stump salvage, wound healing rate, complications, and mortality rate.ResultsTechnical success was 100% with no procedure-related complications. All 4 patients had multilevel vascular disease involving the iliac, common femoral artery, and the profunda femoral artery. All 4 patients were treated with angioplasty and/or stenting of the PFA. The amputation stump was closed primarily in 3 patients and 1 amputation stump was closed with a skin graft. One patient died during the same hospital stay shortly after declining hemodialysis. Three patients are alive at a mean follow-up period of 9 months (range, 5–14 mo).ConclusionsPercutaneous PFA revascularization should be considered, over open revascularization, in patients with persistent above-knee amputation stump ischemia and multiple previous groin surgeries to avoid hip disarticulation.