Total posterior approach for femoropopliteal bypass

Standard approaches to the femoral and popliteal arteries are used in most extremity arterial reconstructions. In unusual circumstances, such as infection, reoperation, or variant anatomy, novel approaches to infrainguinal bypass may be useful, particularly in reoperative or infected cases. One such approach involves exposure of the femoral and popliteal arteries through posterolateral incisions with the patient prone. The major advantage of this exposure is the increased accessibility to the distal above-knee popliteal artery, which is not easily reached through either medial or lateral incisions. This approach also can be useful in cases of significant groin sepsis. The details of this exposure and its application in an illustrative case are presented.