Popliteal-crural bypass through the posterior approach with lesser saphenous vein for limb salvage

PURPOSE: A review of popliteal-crural bypasses via the posterior approach was done to evaluate the results of this technique. METHODS: During a period of 36 months, 21 patients with limb-threatening ischemia underwent 21 popliteal-crural bypasses via the posterior approach in the prone position with reversed lesser saphenous vein. All patients had limb-threatening ischemia, with rest pain in five patients, ulceration in nine patients, and gangrene in seven patients. Diabetes mellitus was present in 17 patients. RESULTS: The inflow site was the supragenicular popliteal artery in 12 patients and the infragenicular popliteal artery in nine patients. The outflow sites were the tibioperoneal trunk in five patients, the posterior tibial artery in six patients, the peroneal artery in eight patients, and the anterior tibial artery in two patients. Of the seven patients with gangrene, three patients underwent transmetatarsal amputation and four underwent toe amputation. The limb salvage rate for the entire group was 100% at 24 months. No early graft failures were seen, and the 12-month and 24-month primary graft patency rates were 89% and 77%, respectively, with life-table analysis. The primary assisted patency rate was 95% at 12 and 24 months. Patency was determined with duplex scan graft surveillance. CONCLUSION: The posterior approach to popliteal-distal bypass is an acceptable alternative to traditional bypass procedure with excellent early patency and limb salvage results. The approach has the advantage of better utilization of lesser saphenous vein and easier operative exposure in patients with short segment infrapopliteal occlusive disease.