Anatomical features of the profunda femoris artery as a factor in the degree of chronic limb ischemia

Introduction . The deep femoral artery is one of the main arteries in the blood supply to the lower limb, becoming an indispensable adjunct to atherosclerotic lesions of the superficial femoral artery and tibial arteries. For many years, the issue of its revascularization has occupied the minds of most vascular surgeons. However, in the minds of many, only the terms «good» or «bad» were used to evaluate its characteristics. Aim . To study the dependence of the severity of lower extremity arterial insufficiency on the type of deep femoral artery structure and the state of the lower limb arterial channel in patients with atherosclerotic limb ischemia. Materials and Methods . The study included 40 women and 80 men, aged from 53 to 84 years (66.7±7.4). The inclusion criteria were the presence of a patent aortoiliac segment, patent deep femoral artery, and occlusion of the femoropopliteal segment. Patients were divided into 2 groups according to the anatomical structure of the deep femoral artery: 1) trunk type; 2) branched type. In order to adequately assess the influence of anatomical parameters on the degree of ischemia, the following characteristics were studied: number of perforating branches; length of the deep femoral artery; number of traversable arterial trunks of the leg. Results . When correlating the types of PFA structure with the degree of limb ischemia, no significant differences were found in the studied groups – p=0.096. However, it should be noted that, numerically, with ischemic damage of degrees III and IV, the dispersed type of PFA structure was found in 4 (22.3%) and 14 (30.1%), respectively. There was also no significant relationship between the degree of limb ischemia and the number of perforating branches of the PFA (p=0.278). Thus, 2 nd order perforating branches were found in 56 (57.1%) patients with the main type of GBA structure and 3 rd order branches – in 32 (32.6%). In contrast to the above results, the analysis of the extent of the PFA demonstrated a significant dependence of the studied indicators. With the extension of the main trunk of the deep femoral artery to the level of the middle-lower third of the thigh, grade 2b ischemia was observed in most cases – 40 (71.4%), while among the patients in other ischemia groups, this indicator was observed only in 8 patients (p=0.001). Conclusion . The extent of the deep femoral artery and preservation of the tibial arterial bed are significant factors influencing the degree of arterial insufficiency.