Lateral approach to the popliteal and crural vessels for limb salvage

Twenty-one patients underwent 23 bypasses for limb salvage via a lateral approach with subcutaneous graft tunneling. The reasons for utilizing a lateral approach were medial infection (10 bypasses), scarring from previous surgery (six), limited vein length available (three), prior local radiotherapy (two) and 'high risk' groin (two). The target artery was the anterior tibial in 16 cases, the peroneal in three, the above-knee popliteal in three and the dorsalis pedis in one. The median (range) follow-up was 22(<1-52) months. There were three early (within 30 days) and four late bypass occlusions, three of which occurred in previously revised bypasses and one in a non-compliant patient. The primary patency at 1 year was 61% and the secondary patency 86%. Only one amputation was required in the whole series. The lateral approach represents a simple solution to threatened limbs in otherwise difficult or complicated situations and may be the ideal approach for free vein grafts to the anterior tibial and distal peroneal arteries.