Surgery of the Deep Femoral Artery

187 Pages·1994·5.9 MB·English

by  PD Dr. med. Marco P. Merlini

M.P. Merlini R.J.A.M. van Dongen M. Dusmet (Eds.)
Surgery of the Deep
Femoral Artery
With 76 Figures
Springer-Verlag
Berlin Heidelberg New York London Paris
Tokyo Hong Kong -Barcelona Budapest
PD Dr. med. MARCO P. MERLIN I
Department of Surgery
Hopital, La Chaux-de-Fonds
Rue de Chasseral 20
CH-2300 La Chaux-de-Fonds
Switzerland
Prof. Dr. med. Dr. h.c. R.J.A.M. VAN DONGEN
P.C. Hoffstraat 153-hs
NL-1071 BT Amsterdam
The Netherlands
Dr. med. MICHAEL DUSMET
Department of Surgery
Centre Hospitalier Universitaire Vaudois
CH-I011 Lausanne
Switzerland
Cover photograph: Anatomic plate (RL 12624) (ca 1501) by Leonardo da
Vinci (1452-1519), reproduced by permission of The Royal Collection, Her
Majesty Queen Elizabeth II.
ISBN-13: 978-3-642-79047-8 e-ISBN-13 :978-3-642-79045-4
DOl: 10.1007/978-3-642-79045-4
Library of Congress Cataloging-in-Publication Data. Surgery of the Deep Femoral Artery /
Marco P. Merlini, (ed.). p. cm. ISBN-13:978-3-642-79047-8
1. Femoral artery-Surgery. I. Merlini, Marco P. [DNLM: 1. Femoral Artery
surgery. WG 595.F3 S961 1994] RD550.S87 1994 617.5'82-cd20 DNLMIDLC for
Library of Congress 94-12558
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© Springer-Verlag Berlin Heidelberg 1994
Softcover reprint of the hardcover 1st edition 1994
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To Maximilien, Nicolas
and Jessica
Foreword
Circulation through the deep femoral artery and its branches is
critical to patients with aortoiliac and infrainguinal arteriosclerosis.
It is, accordingly, essential that all physicians who are seriously
interested in treating patients with lower extremity ischemia have a
good working knowledge of this crucial artery's anatomy and func
tion. It is equally essential that they be aware of arteriosclerotic
disease patterns that involve this important artery, how these
patterns can be Clccurately defined, and, most importantly, what
therapeutic options are available and when they should be used.
All this important information relating to the deep femoral
artery and its surgical significance is included in Dr. Merlini's fine
volume. Eighteen authors have contributed 11 well-edited and
nicely illustrated chapters that provide all the facts that the com
mitted vascular surgeon would ever want to know about the deep
femoral artery and how it should be managed in patients with lower
limb ischemia. Although some of the chapters overlap in some
areas, this adds to the value of the book since the different authors
are' all acknowledged experts and their varying perspectives. are
beneficial to a reader seeking to formulate his own unbiased views.
Dr. Merlini and his collaborators have succeeded in putting
together a book which will be valuable to all those who treat lower
extremity arteriosclerotic ischemia. It is worthwhile for all vascular
surgeons to read this volume since it provides important and
relevant background information on this topic. This book will also
serve as a reference source of factual information and appropriate
literature citations for both trainees and seasoned surgeons seeking
to know more about the deep femoral artery and its role in the
treatment of lower extremity ischemia. It is certain to become a
frequently used and often quoted addition to any vascular surgery
library.
FRANKl. VEITH, MD, FACS
Chief of Vascular Surgical Services,
Montefiore Medical Center, and
Professor of Surgery,
Albert Einstein College of Medicine
New York
Preface
.... you will need to acquire a complete knowledge of the veins and arteries ....
(Leonardo da Vinci)
The deep femoral is the main artery to the thigh and the main
collateral vessel of the lower limb. Intended for a specific vascular
bed, it has, like other arteries, the biological particularity of
extending its function to a much larger area. Ensuring the vas
cularization of the osteoarticular and muscular structures of the
thigh, it allows us to stand, walk, jump, and run. As a collateral
vessel, it can compensate completely for a superficial femoral artery
obstruction and maintain the function and the trophicity of the
lower limb.
Little is known about the hemodynamics of the deep femoral
artery, yet its potentialities are remarkable, going far beyond that
which can be done by a thigh bypass in case of an occlusion of the
superficial femoral artery. It has actually been known for a long
time that the blood flow through an undiseased deep femoral
artery is twice the flow through a femoropopliteal bypass. The
deep femoral artery also establishes the link between the collateral
vessels of the trunk and those of the lower limb and contributes
towards compensating for an obstruction of the iliac axes. In this
situation, it constitutes the reentry route into the lower limb for
the collateral parietal and visceral systems coming from the aorta.
It is truly the central segment of a complex network parallel to the
main vascular axis.
Arteriosclerosis and occasionally a trauma can affect the deep
femoral artery. Such lesions, possibly associated with a proximal
obstructive disease, of the superficial femoral or crural arteries,
can mean the loss of the leg, of physical integrity, and of the free
dom to move about and can lead to suffering for the individual.
Thus, maintaining or reestablishing its blood flow is often the goal
of the vascular surgeon involved in limb salvage.
This book describes this artery in a normal situation and in the
event of superficial femoral obstruction. In the latter case, its role
cannot be dissociated from the condition of the aortoiliac and
crural circulation. The techniques devised and developed to restore
the deep femoral flow are presented from this perspective. Know-
X Preface
ing them makes it possible on many an occasion to avoid a major
amputation by performing a nontraumatizing procedure.
I sincerely thank Miss Corinne Scheidegger for her perfect
organizational work which made it possible to publish this book.
Fe bruary 1994 MARCO P. MERLIN I
Contents
1 Surgical Anatomy of the Deep Femoral Artery
A.B. LUMSDEN, G.L. COLBORN, L.J. SKANDALAKIS,
T.F. DODSON, S.W. GRAY, and J.E. SKANDALAKIS ......... 1
2 Embryology and Phylogenetic Considerations
F. VAAS and R.J.A.M. VAN DONGEN .................... 23
3 Atherosclerotic Lesions of the Deep Femoral Artery -
Profundapopliteal Collateral System
F. VAAS and R.J.A.M VAN DONGEN .................... 29
4 Clinical and Laboratory Investigations
of the Obstruction of the Deep Femoral Artery
W.L. BRECKWOLDT and T.F. O'DONNELL JR ............. 41
5 Roentgenologic Aspects of the Obstruction
of the Deep Femoral Artery
E.V. KINNEY and J.B. TOWNE ......................... 53
6 Indications for Profundaplasty
V.M. BERNHARD ..................................... 67
7 Surgical Approaches
M.Y. SUTER ......................................... 79
8 Deep Femoral Artery Revascularization
M.P. MERLINI ....................................... 91
9 Profundaplasty
R.J.A.M. VAN DONGEN .............................. 111
10 Deep Femoral Artery Reconstruction
A.V. PERSSON and B. LANGE ......................... 147
11 Follow-Up Studies and Conclusions
M. DUSMET ........................................ 167
Subject Index ......................................... 177
List of Contributors
Victor M. Bernhard, MD, Rene J .A.M. van Dongen, MD
FACS Prof. Dr. med., Dr. h.c.,
Professor of Surgery and FACA, FICA
Chairman Emeritus Ordinarius of the
Vascular Surgery Section University of Amsterdam
College of Medicine, University Head of the Department of
of Arizona Vascular Surgery
Tucson, Arizona Boerhaave Kliniek
USA Amsterdam
The Netherlands
William L. Breckwoldt, MD
Assistant Clinical Professor of
Michael Dusmet, MD
Surgery
Chief Resident
Tufts University School of
Department of Surgery
Medicine
Centre Hospitalier Universitaire
Boston, Massachusetts
Vaudois
USA
Lausanne
Switzerland
Gene L. Colborn, PhD
Professor of Anatomy
Stephen W. Gray, PhD
Director of the Center of
Professor Emeritus of Anatomy
Clinical Anatomy
Associate Director of the Thalia
Medical College of Georgia
and Michael Carlos Center
Atlanta, Georgia
for Surgical Anatomy and
USA
Technique
Emory University School of
Thomas F. Dodson, MD, FACS Medicine
Assistant Professor of Surgery Consultant to the Medical Staff
Emory University School of for Congenital Anomalies
Medicine The Piedmont Hospital
Atlanta, Georgia Atlanta, Georgia
USA USA
XIV List of Contributors
Edward V. Kinney, MD Tufts University School of
4001 Kresge Way Medicine
Suite 220 Chief of Surgery and Chief of
Louisville, Kentucky Vascular Surgery
USA New England Medical Center
Boston, Massachusetts
Brian Lange, MD USA
Staff Vascular Surgeon
801 Broadway Alfred V. Persson, MD
Seattle, Washington Medical Director
USA The Vascular Lab, Metrowest
Medical Center
Alan B. Lumsden, MBChB Framingham, Massachusetts
Alfred and Adelle Davis USA
Distinguished Fellow in
Surgical Anatomy and John E. Skandalakis, MD,
Technique PhD, FACS
Fellow in Vascular Surgery Chris Carlos Distinguished
Emory University School of Professor of Surgical
Medicine Anatomy and Technique
Atlanta, Georgia Director of the Thalia and
USA Michael Carlos Center for
Surgical Anatomy and
Marco P. Merlini, MD, FRSM, Technique and the Alfred A.
FACA, FCCP, FICS Davis Research Center for
Privat-Docent and Agrege at Surgical Anatomy and
the Faculty of Medicine Technique
Lausanne Emory University School of
Switzerland Medicine
Head of the Department of Senior Attending Surgeon
Surgery The Piedmont Hospital
Hopital, La Chaux-de-Fonds Clinical Professor of Surgery
Switzerland Medical College of Georgia
Medecin-Adjoint of the Atlanta, Georgia
Department of Surgery USA
Centre Hospitalier Universitaire
Vaudois Lee J. Skandalakis, MD
Lausanne Alfred and Adelle Davis
Switzerland Distinguished Fellow in
Surgical Anatomy and
Thomas F. O'Donnell Jr.,-MD, Technique
FACS Emory University School of
Chairman (pro tempore) Medicine
Department of Surgery Attending Surgeon