Arterial reconstruction for limb salvage: is the terminal peroneal artery a disadvantaged outflow tract?

Arterial reconstructions performed for limb salvage have increasingly used distal perimalleolar and pedal arteries as outflow tracts. However, a paucity of reports comparing the patency and limb salvage rates of these outflow tracts has been published. In this report we examine our experience with distal peroneal artery reconstructions for limb salvage.

During the past 14 years 159 bypasses were performed to the distal peroneal artery (within 5 cm of the malleolus), 157 of which were performed by the medial approach and two by the lateral approach.

Sixty-three percent of the patients were male, 65% were diabetics, and 43% were smokers; the average age was 72.6 years. Sixty-five percent of the bypasses were performed with the in situ technique. Thirty-one percent of the bypasses were performed with translocated or spliced vein technique, and seven (4%) were performed with prosthetic technique. Secondary patency rates for distal peroneal artery bypass grafts at 1 and 5 years were 86% and 75%. The limb salvage rate for distal peroneal artery bypasses was 87% at 5 years. Four hemodynamic failures occurred in this group. Wound complications requiring revision were seen in one patient with a distal peroneal bypass (0.6%). These results do not differ from our results with other perimalleolar vessels.

Arterial reconstruction to the distal peroneal artery has acceptable patency and limb salvage rates. These bypasses are as effective and durable as other perimalleolar bypasses.