The peroneal artery in limb salvage

Abstract

In many patients the progression of atherosclerosis in the lower extremities can be insidious, only becoming manifest with gangrene or an ischemic ulcer. The authors have found, in reviewing their patients with end-stage limb salvage procedures, that the peroneal artery can offer a good bypass vessel in a difficult situation. Over a five-year period they isolated 32 in situ operations performed for gangrene, rest pain, or ischemic ulcers. This represented 8.9% of the 466 vascular operations performed during this time. Of these end-stage cases, 34% (11 limbs, 9 patients) were salvaged by a femoral-peroneal in situ bypass graft. Ankle/arm index preoperatively ranged from 0.0 to .5, the average being .27. In the 11 limbs, all bypasses were immediate successes with the relief of rest pain, the return of adequate circulation, and the improvement of ankle/arm index to an average of .79. Six remained patent until the patient's death. Three are still patent (one year, two years, and four and a half years, respectively) and 2 occluded, necessitating amputation at four months and seven months postoperatively. Therefore, in 9 of 11 limbs (81%) the purpose of salvage was achieved.

The peroneal artery, although a difficult vessel to locate and dissect out, represents a viable option for limb salvage. It does not need to be exposed from the lateral approach and does not require resection of the fibula. It should be approached medially. The peroneal artery, if approached properly and used effectively will often provide the vascular surgeon with an adequate vessel to salvage limbs with end-stage vascular disease.