LAUSR

OBJECTIVES The importance of the profunda femoris for aortoiliac inflow procedure patency is well-recognized. We aim to quantify the characteristics of the profunda femoris and its relation to patency following aortoiliac inflow procedures. METHODS Patients undergoing aortoiliac inflow procedures between 2009 and 2019 were identified. These were classified into aorto-bifemoral bypass (ABF), extra-anatomic bypass (EAB), femoral endarterectomy (FEA) and iliac stenting. Preoperative imaging characteristics of the profunda femoris were reviewed as well as outcomes. RESULTS We performed 269 procedures in 202 patients. 162 were men (59.8%) with a mean age of 61 (SD 11.45). 123 patients (45.3%) presented with claudication, 69 (25.9%) with critical limb ischemia and 30 (11.2%) with acute limb ischemia. 50 patients (18.6%) underwent ABF, 44 (16.4%) underwent EAB, 57 (21.2%) underwent FEA and 158 (58.7%) underwent iliac stenting. 14 patients (5.2%) underwent FEA plus iliac stenting. 52 patients (19.2%) had an occluded superficial femoral artery. 24 patients (8.9%) had additional outflow procedures performed during the index operation; including infrainguinal endovascular intervention in 10 patients (3.7%), infrainguinal bypass in 10 (3.7%) and femoropopliteal thrombectomy in 5 (1.9%). Mean follow-up was 17.5 months with overall 2-year primary patency (PP) of 79%. 2-year PP was 94.7% for FEA, 85.6% for ABF, 79.8% for iliac stents, 62.5% for EAB. Unadjusted analysis revealed that loss of primary assisted patency was associated with active smoking (67.6% vs 48.6% p=0.035), lower creatinine (Mean 0.84 vs 1.06, p=0.003), critical limb ischemia versus claudication (37.8% vs 21.4%, p=0.037) and profunda femoris with fewer than 5 branches >2mm in size (88.2% vs 68.5%, p=0.011). Multivariate analysis confirmed that a profunda with 5 or more branches >2mm in diameter was significantly associated with a lower risk of thrombosis (OR 0.30, p = 0.034). Size of the profunda greater than 6mm approached statistical significance on univariate analysis (35% of the non-thrombosed vs 21% in the thrombosed, p=0.073), but did not significantly affect risk of thrombosis on the multivariate analysis (OR 0.58, p = 0.25). The 2-year PP when all operations were considered was 76% compared to 72% for profunda with fewer than 5 branches > 2mm. CONCLUSIONS Anatomic characteristics of the profunda are associated with patency of inflow procedures. Care should be taken to assess the main profunda and branch diameters on preoperative imaging. A concomitant infrainguinal procedure should be considered in cases of profunda with inadequate large branches, to ensure long-term patency of the inflow operation.