[Medial approach to the anterior tibial artery]

The medial, transmembranous route is a simple way of approaching the anterior tibial artery in its middle third. The limb is elevated, the leg flexed and the thigh placed in external rotation. The incision, which follows the course of the great saphenous vein, begins 10 cm above the tibial malleolus and is 10 cm long. The soleus and long flexor muscle of toes are gently disinserted, and the posterior tibial muscle is retracted to expose the interosseous membrane which is split, displaying the artery. The main indication of this technique is tibio-saphenous bypass in situ, but the bypass can be performed with the posterior tibial artery or the peroneal artery, using the same approach.