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

Background: Little 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. Methods: We 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. Results: Technical 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). Conclusions: Percutaneous 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.