The ultimate value of profundaplasty in the management of lower extremity ischemia was determined by multifactoral analysis of 239 operated limbs in 209 patients followed up to 110 months. In patients who underwent operation for claudication (n=83), patency without the need for subsequent revision or distal bypass was achieved in 77% at 5 years. By contrast, profundaplasty patency was maintained in only 23% of 154 limbs operated upon for salvage. The patient survival rate was 75% at 5 years and 56% at 7 years among the claudication group but only 29% at both 5 and 7 years in the limb salvage group. Of the 104 survivors in the limb salvage category, 43 required amputation, 79% within the first year, and 13 limbs were saved by additional revascularization procedures. Profundaplasty is a durable procedure for relief of claudication. However, it is significantly less effective in patients threatened with limb loss. When amputation is inevitable, effective profunda perfusion is essential for preservation of the knee joint.