Vascular

Femoral-Popliteal Bypass (Below Knee)

OPERATION: Femoral-Popliteal Bypass (Below Knee)
ANAESTHETIC: General / spinal anaesthesia
ANTIBIOTICS: IV antibiotics at induction if prosthetic graft
POSITION: Supine. Leg prepared circumferentially from groin to foot.

INDICATION:
Critical limb ischaemia. Preoperative duplex / CT angiography: SFA occlusion, patent below-knee popliteal artery. Long saphenous vein preferred conduit — confirmed patent and adequate calibre.

PROCEDURE:
Proceeds as for above-knee femoral-popliteal bypass with the following differences:

POPLITEAL EXPOSURE (below knee):
Medial incision below knee joint behind the medial border of tibia. Deep fascia divided. Popliteal artery identified and slung in the below-knee popliteal fossa posterior to tibia, between gastrocnemius heads.