Use of Peroneal Artery for Revascularization of the Lower Extremity

The popliteal artery is most commonly used as the site of the distal anastomosis in bypass grafts of the lower extremity. However, occasionally the occlusive atherosclerotic process extends beyond the popliteal artery and involves the trifurcation vessels, rendering the popliteal artery unsuitable for the bypass. When this occurs it appears that the peroneal artery is less frequently involved than either the anterior or posterior tibial vessels.^1,2

There have been several reports in the literature describing shunt grafts from the femoral artery to the anterior and posterior tibial vessels.^3,4 The present study describes the direct operative approach to the upper third of the peroneal artery. Investigation of the feasibility of this operation was prompted by several patients who presented to the vascular service of the Strong Memorial Hospital with advanced atherosclerosis of the lower extremity in which the peroneal artery was the only radiographically patent vessel below the knee.