Value of the Deep Femoral Artery as Alternative Inflow Source in Infrainguinal Bypass Surgery

Background: The purpose of this study was to analyze the long-term results of infrainguinal bypass surgery using the deep femoral artery (DFA) as the inflow source. Methods: Between 1998 and 2011, 88 bypasses of the lower limb were placed in 86 patients (mean age 71 years) using the deep femoral artery as inflow. Patients' records were retrieved from a computerized database and analyzed retrospectively. Results: Critical limb ischemia (rest pain/tissue loss) was the indication in the majority (87.5%) of cases. The distal anastomosis of the bypass grafts was located at the popliteal level in 32 cases and the tibial (pedal) level in 52 cases, respectively, with the autologous vein as conduit in 94% of cases. Perioperative mortality was 2.3% and 77 patients (79 limbs) were followed over a mean period of 48 months. Overall primary, primary assisted, and secondary patency rates of 64.2%, 74.9%, and 92.3% were noted at 60 months, respectively. The limb salvage rate was 97%, with an overall survival of 48.7% at 60 months. Conclusions: The deep femoral artery can serve as reliable inflow source for infrainguinal bypass surgery in difficult situations like redo groin surgery, limited conduit length, and circumferential nonobstructive calcification of the common femoral artery.