Posterior approach for simultaneous access to the popliteal and anterior tibial arteries: applications to distal arterial bypass

Arterial surgery to salvage the lower limb tends to make use of the great s aphenous vein, harvested with the subject in the supine position. If this i s not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a peroperative modification o f the procedure. A bypass between the popliteal and anterior tibial arterie s can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral c ompartment of the leg, these approaches are not applicable. In such cases w e propose a single posterior approach. The single posterior approach was us ed on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10cm above the lateral malleolus, the Achilles tendon and short fibular ve ssels were retracted medially to expose the interosseous fascia, which was divided over 10 cm. Medial rotation of the limb by 30 degrees exposed the a nterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection w as necessary, whereas on remaining 7 medial rotation enabled excellent expo sure of the anterior tibial artery. The single posterior approach to the an terior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal arter y and the anterior tibial artery.