ARE PERONEAL ARTERY BYPASS GRAFTS HEMODYNAMICALLY INFERIOR TO OTHER TIBIAL ARTERY BYPASS GRAFTS

Purpose: Many authors have reported excellent long-term patency rates of peroneal artery bypasses. It has been suggested, however, that the hemodynamic result of the peroneal bypass is inferior to that of other infrapopliteal artery bypasses, making it suboptimal in patients with forefoot ischemic tissue loss. A retrospective review of 118 recent i nfrainguinal vein grafts (36 peroneal, 27 anterior tibial, 35 posterio r tibial, 20 popliteal) was undertaken to assess and compare the hemod ynamic results for each group. Methods: We reviewed the hemodynamic re sults of 36 peroneal bypass grafts assessed by preoperative and postop erative ankle-brachial index and transmetatarsal pulse volume recordin g, duplex scan-derived distal graft peak systolic flow velocity, and i ntraoperatively measured outflow resistance. These results were compar ed with a concurrent series of anterior tibial, posterior tibial, and popliteal artery bypass grafts. All but one of the infrapopliteal bypa ss grafts were performed for limb salvage, and 65% of patients had isc hemic ulcerations or gangrene. Results: There was no difference in pos toperative ankle-brachial index, postoperative transmetatarsal pulse v olume recording, peak systolic flow velocity, or measured outflow resi stance among the four different outflow groups. All patients with pero neal bypass grafts had healed wounds within a mean follow-up period of 17 months. There were no hemodynamic failures. Conclusion: Peroneal a rtery bypass grafts achieved hemodynamic results equivalent to anterio r tibial, posterior tibial, and popliteal artery bypass grafts.