Posterior exposure for popliteal-crural bypass: a useful approach

The distal popliteal artery and proximal crural vessels represent common locations for atherosclerotic occlusive disease, especially in the diabetic subpopulation. Symptoms such as pain at rest, distal ulceration, and gangrene are associated with a high risk of limb loss unless arterial flow can be restored. Surgical revascularization is the most appropriate treatment in these patients, using autogenous vein to bypass from the popliteal artery to a crural artery beyond the area of stenosis. The posterior approach is an ideal method with which to achieve this goal. Lesser saphenous vein may be harvested from the same incision used to expose the inflow and outflow vessels. The technique minimizes the length of required conduit and preserves the greater saphenous vein for subsequent use. The wound problems associated with medial vein harvest incisions are less frequent. A through knowledge of the anatomy of the region will allow one to use the posterior approach in selected patients with popliteal and infrapopliteal occlusive disease, providing an additional tool for use in patients with limb-threatening lower extremity ischemia.