DO RESULTS JUSTIFY AN AGGRESSIVE STRATEGY TARGETING THE PEDAL ARTERIES FOR LIMB SALVAGE

We initiated a strategy to bypass all of the significant popliteal and tibial disease in the setting of Limb-threatening ischemia beginning in September 1986. Of 194 infrapopliteal bypasses performed for limb s alvage during the ensuing 6 years, 111 (57%) autogenous vein bypasses were performed to the pedal vessels at or distal 60 the ankle. By life table analysis, primary graft patency at 60 months for pedal bypasses was 57%, with salvage of failed grafts resulting in secondary patency of 61%. Limb salvage was 64% at 60 months. Of 33 graft thromboses, 24 (73%) resulted in eventual limb loss. Five limbs were amputated due t o wound complications or progressive forefoot sepsis despite patent pe dal grafts. More bypasses were performed to the dorsalis pedis than th e posterior tibial at the ankle (78 vs 33), but patency and Limb salva ge were similar. Bypasses 60 the pedal arteries resulted in superior l imb salvage compared with peroneal bypass when forefoot tissue necrosi s was present (63 vs 33% at 36 months, P = 0.048). Pedal grafts had co mparable overall patency (57 vs 64%) and limb salvage (64 vs 75%) to m ore proximal tibial bypasses. Pedal bypass provides acceptable long-te rm outcomes for both patency and limb salvage. When forefoot ischemic tissue loss is present, pedal bypass, when feasible, appears preferabl e to peroneal bypass. (C) 1995 Academic Press, Inc.