The role of the peroneal artery for limb salvage.

Peroneal artery revascularization was performed in 61 cases for limb salvage and compared to a comparable group of 89 tibial artery reconstructions. Preoperative arteriography is essential to define runoff quality and pedal arch integrity. Intraoperative arteriography and flow determinations minimize failures due to technical error and provide some indication of the prognosis for graft patency. Failure to augment flow by at least 50% suggests pedal arch deficiency and is predictive for early graft closure. Cumulative patency for peroneal bypass was 55 +/- 8% at 1 year and 38 +/- 10% at 30 months compared to 63 +/- 6 and 59 +/- 7% for tibial reconstructions at the same time intervals. Most graft failures occurred within the first six months. Nineteen peroneals have been followed for more than one year with only three failures occurring. Improved criteria for case selection resulted in an 80% decrease in the number of failed grafts for the second half of this series. A similar reduction was noted for secondary operations. Results obtained with good quality saphenous veins (37 +/- 13% at 30 months) and glutaraldehyde tanned umbilical veins (53 +/- 11%) depend more on technical, pathologic and biologic factors than on the particular graft material employed. The mortality rate at 30 days was 3.3% and compared favorably with other limb salvage procedures and with primary amputations. Cumulative patient survival with functional limbs was 79 +/- 9% at 30 months and was distinctly superior to reported data on survival of amputees. A cumulative limb salvage rate of 79 +/- 6% at 30 months for the peroneal group makes such reconstructions definitely favorable to uniform limb ablation.