Can the deep femoral artery be used reliably as an inflow source for infrainguinal reconstruction? Long-term results in 563 procedures.

Purpose: Historically, most infrainguinal bypasses originated from the common femoral artery. In spite of sporadic reports of the use of the deep femoral artery as an inflow source, its durability has not been critically reviewed.

Methods: From 1977 to 1994, 2829 infrainguinal reconstructions have been performed. Of these, 563 (20%) procedures have been performed with the deep femoral artery used as the inflow source. The indication for operation was limb salvage in 91.5% of cases. Four hundred eleven procedures were performed with use of the saphenous vein in situ, 48 were performed with partial in situ vein, and 75 were performed with excised (translocated) vein (29 other). When the deep femoral artery was relatively disease free, it was accessed through a lateral or standard inguinal approach. Reasons given for the use of the deep femoral artery were inadequate vein length, concomitant inflow procedures, prior groin dissections, and occluded superficial femoral artery.

Results: The 1- and 5-year secondary patency rates for all bypasses with the deep femoral artery were 90.4% and 76.9%, respectively, as compared with 88% and 73.3% for common femoral artery-based bypasses. Sixty-five patients (11.5%) had concomitant inflow procedures. All patients were monitored with serial noninvasive examinations, and data were collected from the vascular registry. Only eight patients (1.6%) required further inflow reconstructions for salvage of bypasses.

Conclusions: The hemodynamically unobstructed deep femoral artery is a reliable and durable inflow source for patients requiring infrainguinal bypasses. Its patency rates are comparable to those of the common femoral artery-based reconstructions in our experience.