Peroneal artery bypass: a reappraisal of its value in limb salvage

In general the surgical literature has expressed pessimism about the value of bypass to the peroneal artery for limb salvage. The combination of greater technical difficulty, low patency rates, and hemodynamic failures have led to the establishment of this prejudice. In a review of 284 arteriograms in limbs with infrapopliteal arterial occlusion, the peroneal artery was the least diseased in 40% and was the only available vessel in 37% of instances. One hundred fifty-two peroneal bypasses have been performed in a 7-year period, 116 by the in situ method, 23 with excised vein, and 13 by nonautogenous conduits. During the same period 125 anterior tibial and 114 posterior tibial bypasses were also done. The mean preoperative ankle/brachial indices were 0.27 for peroneal, 0.25 for anterior tibial, and 0.29 for posterior tibial bypasses. These were converted to mean postoperative indices of 0.84, 0.86, and 0.92, respectively. Corresponding transmetatarsal/brachial indices were 0.72, 0.75, and 0.90. Rest pain was relieved in all these patients, and in 94 patients with tissue loss, there were 11 major amputations, nine healed forefoot amputations, and 20 healed digital ray amputations. Hemodynamic failures were two in the peroneal, two in the anterior tibial, and three in the posterior tibial group with one perioperative amputation in each. The cumulative limb salvage rate at 3 years for the peroneal group was 81%. This experience has shown that the patency and limb salvage rates obtained are comparable to those for the anterior and posterior tibial arteries and that hemodynamic failure is an uncommon occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)