Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene.

OBJECTIVE

To determine if peroneal bypass is a suitable alternative to inframalleolar bypass in patients with ischemic pedal gangrene.

DESIGN

Review of a prospectively acquired vascular registry.

SETTING

University practice limited to vascular surgery.

PATIENTS

Patients with chronic lower-extremity ischemia and pedal gangrene evaluated between 1985 and 1995 in whom the only options for arterial reconstruction were bypass to the peroneal or an inframalleolar artery.

INTERVENTIONS

Peroneal or inframalleolar reverse vein bypass.

MAIN OUTCOME MEASURES

Time to healing and lifetable analyses of survival, primary patency, and limb salvage.

RESULTS

Eighty-three peroneal and 46 pedal bypasses were performed for ischemic foot gangrene. The groups were equivalent for sex, diabetes mellitus, heart disease, hypertension, renal failure, hypercoagulable states, previous ipsilateral bypass, smoking, and preoperative ankle-brachial indices. Patients with inframalleolar bypass were younger than patients with peroneal bypass (63.9 vs 71.6 years, P = .005) and had higher postoperative ankle-brachial indices (1.02 vs 0.91, P = .004). However, 3-year survival rates (69.1% inframalleolar vs 60.0% peroneal, P = .35), limb salvage rates at 2 years (70.3% vs 85.8%, P = .10), and time to wound healing (19.7 vs 21.6 weeks, P = .66) were equivalent.

CONCLUSION

Peroneal and inframalleolar bypass for ischemic pedal gangrene have equivalent intermediate-term survival, limb salvage, and wound healing. Surgeons should not feel obliged to perform inframalleolar bypass for pedal gangrene if peroneal bypass is possible.