Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene

Ahmed M. Abou-Zamzam, Gregory (Greg) Moneta, Raymond W. Lee, Mark R. Nehler, Lloyd M. Taylor, John M. Porter

    Research output: Contribution to journalArticle

    37 Citations (Scopus)

    Abstract

    Objective: To determine if peroneal bypass is a suitable alternative to inframalleolar bypass in patients with ischemic pedal gangrene. Design: Review era 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 life-table 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.

    Original languageEnglish (US)
    Pages (from-to)894-899
    Number of pages6
    JournalArchives of Surgery
    Volume131
    Issue number8
    StatePublished - Aug 1996

    Fingerprint

    Gangrene
    Foot
    Limb Salvage
    Ankle Brachial Index
    Wound Healing
    Blood Vessels
    Life Tables
    Survival
    Renal Insufficiency
    Registries
    Lower Extremity
    Veins
    Heart Diseases
    Diabetes Mellitus
    Ischemia
    Survival Rate
    Arteries
    Smoking
    Outcome Assessment (Health Care)
    Hypertension

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Abou-Zamzam, A. M., Moneta, G. G., Lee, R. W., Nehler, M. R., Taylor, L. M., & Porter, J. M. (1996). Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene. Archives of Surgery, 131(8), 894-899.

    Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene. / Abou-Zamzam, Ahmed M.; Moneta, Gregory (Greg); Lee, Raymond W.; Nehler, Mark R.; Taylor, Lloyd M.; Porter, John M.

    In: Archives of Surgery, Vol. 131, No. 8, 08.1996, p. 894-899.

    Research output: Contribution to journalArticle

    Abou-Zamzam, AM, Moneta, GG, Lee, RW, Nehler, MR, Taylor, LM & Porter, JM 1996, 'Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene', Archives of Surgery, vol. 131, no. 8, pp. 894-899.
    Abou-Zamzam AM, Moneta GG, Lee RW, Nehler MR, Taylor LM, Porter JM. Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene. Archives of Surgery. 1996 Aug;131(8):894-899.
    Abou-Zamzam, Ahmed M. ; Moneta, Gregory (Greg) ; Lee, Raymond W. ; Nehler, Mark R. ; Taylor, Lloyd M. ; Porter, John M. / Peroneal bypass is equivalent to inframalleolar bypass for ischemic pedal gangrene. In: Archives of Surgery. 1996 ; Vol. 131, No. 8. pp. 894-899.
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    abstract = "Objective: To determine if peroneal bypass is a suitable alternative to inframalleolar bypass in patients with ischemic pedal gangrene. Design: Review era 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 life-table 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.",
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    AU - Nehler, Mark R.

    AU - Taylor, Lloyd M.

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