Choice of peroneal or dorsalis pedis artery bypass for limb salvage

Arterial bypasses performed for limb salvage have increasingly used peroneal and pedal arteries as outflow. However, few reports have been published that compare the patency of limb salvage of these alternative outflow tracts. In this report, we have examined our experience with peroneal and dorsalis pedis (DP) artery bypasses for limb salvage.

Of more than 3,000 infrainguinal reconstructions performed for limb salvage, 732 were completed to the peroneal artery. During the same period, 238 bypasses were performed to the DP artery. Patient demographics were similar in both groups. The in situ technique was used in 68% of the peroneal bypasses and in 66% of the DP bypasses, respectively. Translocated veins were used in 28% of bypasses, and spliced veins were used in 32%.

Secondary patency rates for the DP bypass at 1 and 5 years were 89% and 67%, respectively, as compared with 89% and 78% for the peroneal artery bypass. Limb salvage rates for the DP bypass were 94% at 1 year and 86% at 5 years, as compared with 96% and 93% at 1 and 5 years, respectively, for the peroneal artery bypass. No statistical difference was found. Four (1.7%) hemodynamic failures occurred in the DP group and 10 (1.4%) in the peroneal group. Wound complications were seen in 9 (3%) patients in the DP group and in 11 (1.5%) in the peroneal group.

This experience indicates that both peroneal and DP bypasses have acceptable patency and limb salvage rates. Selection of one of these two outflow tracts, where a choice exists, may depend on the conduit limitation and adjacent tissue infection; however, both outflow tracts are durable and hemodynamically effective for limb salvage.