ARTERIAL RECONSTRUCTION FOR LIMB SALVAGE - IS THE TERMINAL PERONEAL ARTERY A DISADVANTAGED OUTFLOW TRACT

Background. Arterial reconstructions performed for limb salvage have i ncreasingly used distal perimalleolar and pedal arteries as outflow tr acts. However, a paucity of reports comparing the patency and limb sal vage rates of these outflow tracts has been published. In this report we examine our experience with distal peroneal artery reconstructions for limb salvage. Methods, 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 la teral approach. Results, Sixty-three percent of the patients were male , 65% were diabetics, and 43% were smokers; the average age was 72.6 y eats. Sixty-five percent of the bypasses were performed with the in si tu technique. Thirty-one percent of the bypasses were performed with t ranslocated or spliced vein technique, and seven (4%) were performed w ith prosthetic technique. Secondary patency rates for distal peroneal artery bypass grafts at 1 and 5 years were 86% and 75%. The limb salva ge rate for distal peroneal artery bypasses was 87% at 5 years. Four h emodynamic failures occurred in this group. Would complications requir ing revision were seen in one patient with a distal peroneal bypass (0 .6%). These results do not differ from our results with other perimall eolar vessels. Conclusions, Arterial reconstruction to the distal pero neal artery has acceptable patency and limb salvage rates. These bypas ses are as effective and durable as other perimalleolar bypasses.