title: Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene.
abstract: OBJECTIVE
  To determine if peroneal bypass is a suitable alternative to inframalleolar bypass in patients with ischemic pedal gangrene.
  
  
  METHODS
  Review of a prospectively acquired vascular registry.
  
  
  METHODS
  University practice limited to vascular surgery.
  
  
  METHODS
  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.
  
  
  METHODS
  Peroneal or inframalleolar reverse vein bypass.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Abou-Zamzam
authors.forename: G L
authors.initials: GL
authors.lastname: Moneta
authors.forename: R W
authors.initials: RW
authors.lastname: Lee
authors.forename: M R
authors.initials: MR
authors.lastname: Nehler
authors.forename: L M
authors.initials: LM
authors.lastname: Taylor
authors.forename: J M
authors.initials: JM
authors.lastname: Porter
mesh_terms: D000368:Aged; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D005528:Foot / Q000098:blood supply* / Q000473:pathology; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D016019:Survival Analysis; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome; D014654:Vascular Patency; D014945:Wound Healing