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Limitations of peroneal artery bypass grafting for limb salvage
B M Elliott1, J G Robison, T E Brothers
1Department of Surgery, Medical University of South Carolina, Charleston 29425-0901.
Insights
Peroneal bypass grafts show similar patency to other bypasses but worse limb salvage. Consider alternatives for peroneal artery bypass grafting in cases with poor anatomy or tissue necrosis.
Area of Science:
- Vascular Surgery
- Reconstructive Surgery
- Limb Salvage Procedures
Background:
- Peroneal artery bypass grafting is a reconstructive option for limb salvage.
- Its efficacy relative to other tibial and pedal bypass grafts requires evaluation.
Purpose of the Study:
- To compare the outcomes of peroneal bypass grafting for limb salvage with concurrent tibial and pedal bypass grafts.
- To identify anatomical factors influencing peroneal bypass graft success.
Main Methods:
- A retrospective review of 34 peroneal bypass grafts for limb salvage out of 194 total bypasses (September 1986 - June 1992).
- Analysis of preoperative and intraoperative arteriograms to identify anatomical predictors of success.
- Life-table analysis was used to compare secondary patency and limb salvage rates.
Main Results:
- Secondary patency rates at 48 months were comparable: 70% for peroneal grafts vs. 65% for other grafts.
- Limb salvage rates at 48 months were significantly lower for peroneal grafts (55%) compared to other grafts (67%).
- Factors associated with peroneal bypass failure included short graft length (<10 cm), small artery diameter (<2 mm), poor foot perfusion, and absent pedal arch visualization.
Conclusions:
- Peroneal bypass grafting can achieve limb salvage in selected cases but has a higher failure rate than other bypasses, especially with unfavorable anatomy.
- Alternatives should be considered for peroneal artery bypass grafting when anatomical conditions are poor, particularly with forefoot tissue necrosis.
Purpose:
The purpose of this study was to compare the results of peroneal bypass grafting for limb salvage with the results of other tibial and pedal bypass grafts performed concurrently.
Methods:
Thirty-four peroneal bypass grafts with autologous vein were performed for limb salvage between September 1986 and June 1992. These constituted 18% of an overall experience of 194 tibial or pedal bypasses performed during that time. Preoperative and intraoperative arteriograms were reviewed to identify anatomic characteristics associated with successful limb salvage.
Results:
Secondary patency rates for peroneal bypass grafts (70%) compared with the other tibial and pedal bypass grafts (65%) did not differ significantly at 48 months by life-table analysis. Limb salvage achieved by peroneal artery bypass grafting was significantly worse (55%) than that achieved by the remaining tibial and pedal bypasses (67%) at 48 months. Limb salvage was 33% at 7 months for those undergoing peroneal artery bypass grafting as opposed to 57% at 48 months for patients undergoing other tibial or pedal revascularizations with tissue necrosis. Four anatomic features were identified that were associated with failure after peroneal artery bypass grafting. These were peroneal length less than 10 cm (p = 0.012), peroneal artery diameter less than 2 mm (p = 0.035), absence of arteriographically demonstrated collaterals perfusing the foot (p = 0.0001), and little or no visualization of the pedal arch (p = 0.008).
Conclusions:
Although successful grafts may avoid amputation in carefully selected cases, alternatives to peroneal artery bypass grafting should be considered when less than favorable anatomic conditions are encountered, particularly in the presence of forefoot tissue necrosis.