Posterior Approach to the Popliteal to Peroneal Bypass

Critical limb ischemia (CLI) is a clinical syndrome related to peripheral artery disease (PAD) that is marked by ischemic rest pain or tissue loss such as nonhealing ulcers or gangrene. Without revascularization CLI carries a 30-50% risk of major limb amputation within 1 year. Initial surgical revascularization is recommended for patients with CLI who have a greater than 2-year life expectancy. We present the case of a 92-year-old male with severe peripheral artery disease with gangrene of bilateral toes who underwent right popliteal to distal peroneal bypass via the posterior approach using ipsilateral reversed GSV. The posterior approach provides excellent exposure and should be considered in distal surgical revascularization where the popliteal artery serves as inflow and distal peroneal artery as target outflow vessel.