The standard profundaplasty is a patch angioplasty. No doubt, it is a nice way but not without weaknesses. If you use a vein patch you must (usually) use the great saphenous vein. If you use a synthetic patch, then there is always the danger of infection. Is there any other way?

I could say yes. You can use some other autologous-like material as a patch, like bovine pericardium. But what about a cheap, totally autologous way? It is the “Transposition of the femoral bifurcation”. Let’s say a few words about it.

You make an incision along the common femoral artery (CFA) to its bifurcation. Then, the incision continues both at the superficial femoral artery (SFA) and the profunda femoris artery (PFA) at a “Y” shape.

A standard endarterectomy is performed in all three vessels as long as you need: CFA, SFA, and PFA. A significant detail is to keep the length of arteriotomies at the SFA and PFA approximately the same.

Then, the arteriotomy is closed using two running sutures. The first one begins at the point of femoral junction, continuing between the adjacent sides of the SFA and the PFA, posteriorly first and then anteriorly. After you have completed the closure of SFA and PFA, start with another suture from the top-end of the CFA.

You can see this technique in the following video:

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