Many authors have reported excellent long-term patency rates of peroneal artery bypasses. It has been suggested, however, that the hemodynamic result of the peroneal bypass is inferior to that of other infrapopliteal artery bypasses, making it suboptimal in patients with forefoot ischemic tissue loss. A retrospective review of US recent infrafuguinal vein grafts (36 peroneal, 27 anterior tibial, 35 posterior tibial, 20 popliteal) waS undertaken to assess and compare the hemodynamic results for each group. Methods: We reviewed the hemodynamic results of 36 peroneal bypass grafts assessed by preoperative and postoperative ankle-brachial index and transmetatarsal pulse volume recording, duplex scan-derived distal graft peak systolic flow velocity, and intraoperatively measured outflow resistance. These results were compared with a concurtent series of anterior tibial, posterior tibial, and popliteal artery bypass grafts. All but one of the infrapopliteal bypass grafts were performed for limb salvage, and 65% of patients had ischemic ulcerations or gangrene. Results: There was no difference in postoperative ankle-brachial index, postoperative transmetatarsal pulse volume recording, peak systolic flow velocity, or measured outflow resistance among the four different outflow groups. All patients with peroneal bypass grafts had healed wounds within a mean follow-up period of 17 months. There were no hemodynamic failures. Conclusion: Peroneal artery bypass grafts achieved hemodynamic results equivalent to anterior tibial, posterior tibial, and popliteal artery bypass grafts.

No abstract

In patients with familial CBTs, high-resolution computed tomography is recommended for early screening as a means of prompting diagnosis and definitive treatment, an approach that minimizes morbidity and facilitates surgical excision.