DETERMINANTS OF SUCCESSFUL PERONEAL ARTERY BYPASS

Purpose: The purpose of this study was to identify the determinants of long-term success with the peroneal artery bypass. Methods: Seventy-seven consecutive peroneal artery bypasses performed between 1981 and 1990 were reviewed to evaluate the influence of venous conduit modification, surgeon experience, patency of the dorsalis pedis or posterior tibial artery at the ankle, and the quality of the peroneal collateral branches and pedal arch. The average follow-up was 34 months (range 1 to 92 months). Results. The 5-year primary and secondary patency rates were 61% and 92%, respectively. Modification of the vein graft at the initial procedure was necessary in 26 (34%). This led to a reduced (p < 0.001) 5-year primary patency rate of 22% compared with 80% for unmodified conduits. Operative results improved with surgeon experience. The 5-year secondary patency rate of grafts placed before 1985 was 82% compared with 98% for subsequent grafts (p < 0.03). The initial postoperative mean ankle/brachial index for grafts revised for hemodynamic failure or thrombosis in the follow-up period was 0.84 compared with 0.95 in grafts that did not require revision (p < 0.04). The presence of a patent dorsalis pedis or posterior tibial artery at the ankle and an intact pedal arch did not significantly influence primary or secondary patency. The 5-year secondary graft patency rate for patients with a patent dorsalis pedis or posterior tibial artery at the ankle was 88%. Conclusions: The peroneal artery should be selected for outflow when it is the single tibial runoff vessel and is preferable to a bypass to an inframalleolar arterial segment. The quality of the venous conduit and the technical skill of the surgeon are the two most important factors in the success of bypasses to the peroneal artery.