Exposure of the anterior tibial artery by medial popliteal extension

This report describes exploration of the proximal anterior tibial artery by extension of the standard below-knee approach to the popliteal artery. The anterior tibial artery is "poplitealized," giving excellent access to perform an anastomosis. The proximal medial approach depends on precise arteriography and is particularly suited to the in situ saphenous vein bypass and redo surgery. Advantages over previously described exposures include a shorter graft, ease of graft alignment, protection of the peroneal nerve, and the absence of a lateral counterincision. This exposure has been used on 12 of 14 anterior tibial grafts during the past 2 years.