PEDAL OR PERONEAL BYPASS - WHICH IS BETTER WHEN BOTH ARE PATENT

Purpose: We compared autogenous vein pedal and peroneal bypasses, focu sing on extremities that could have a bypass to either artery. Methods : From 1985 to 1993 we performed a total of 175 pedal and 77 peroneal autogenous vein bypasses for rest pain (rt = 75, 30%) and tissue loss (n = 177, 70%). One hundred ninety-six (78%) in situ saphenous vein an d 56 (22%) reversed or composite vein bypasses were performed. One hun dred fifty-two of these 252 bypasses were performed in extremities wit h both the pedal and peroneal arteries patent by arteriography. The va scular surgeon chose to perform 99 pedal and 53 peroneal vein bypasses in these 152 extremities. Results: The angiogram score of the outflow arteries were similar for pedal and peroneal bypasses with the Societ y for Vascular Surgery and the International Society for Cardiovascula r Surgery and modified scoring systems. At 2 years the primary and sec ondary patency rates for pedal bypasses (70% and 77%) were not signifi cantly different compared with those for peroneal bypasses (60% and 72 %). Limb salvage rates at 2 years were similar for pedal and peroneal bypasses for all patients (74% and 73%), patients with both pedal and peroneal arteries patent (83% and 72%), diabetics (76% and 66%), and p atients with tissue necrosis (77% and 71%). Conclusions: Pedal and per oneal artery bypasses with equivalent angiogram scores have similar lo ng-term graft patency and limb salvage. The choice between pedal or pe roneal artery bypass should be based on the quality of vein and the su rgeon's preference.