DETERMINANTS OF PERONEAL ARTERY BYPASS FAILURE

Although the peroneal artery often remains patent despite occlusion of other infrageniculate arteries, there is skepticism regarding its use for distal bypass for salvage when a patent inframalleolar artery is present. The authors reviewed their experience with lower extremity ar terial bypass for occlusive disease to determine predictors of peronea l artery bypass failure. The records of all patients undergoing bypass to the peroneal artery for atherosclerotic occlusive disease were rev iewed. Patient demographics, operative indications, and the quality of peroneal runoff were evaluated for their contribution to bypass failu re. Between 1976 and 1996, 925 bypasses were performed to the peroneal artery. The indications for operation were limb salvage in 875 (95%). The graft patency rate was 89% and 77% and the limb salvage rate was 96% and 93% at 1 and 5 years, respectively. Bypass conduits included i n situ vein (66%), excised vein (31%), and synthetic graft (3%). There were 139 bypass occlusions, of which 27 were revised. The causes of b ypass occlusion were conduit failure (66%), inflow lesion (12%), and o utflow lesion (22%). There were 18 hemodynamic failures. Thirteen (72% ) of these were secondary to inadequate perfusion of the foot. However , 69% of these patients achieved salvage with a jump bypass to a paten t more distal vessel. Revisions were performed equally for inflow dise ase, conduit stenosis, and hemodynamically significant arteriovenous f istulae. Patient demographics; operative indication, including the sit e of tissue loss; or quality of peroneal artery runoff did not predict bypass occlusion or hemodynamic failure. The peroneal artery remains an excellent choice of infrageniculate arterial bypass for occlusive d isease. The quality of the venous conduit rather than proximity of the distal anastomosis to an area of tissue ischemia should be the primar y concern in deciding on distal bypass. No other variables correlated with bypass failure.