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Popliteal artery aneurysm: resection and revascularization with a great saphenous vein interposition graft (posterior approach)

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  1. Harvesting the vein graft (greater saphenous vein on right)

    Video
    Harvesting the vein graft (greater saphenous vein on right)
    Soundsettings

    Start the longitudinal skin incision at the level where the greater saphenous vein (GSV) terminates in the femoral vein. Expose the saphenofemoral junction step by step and divide its branches between simple ligatures. At the level where it terminates in the deep vein, clamp and divide the GSV and secure the GSV stump with a suture ligature. Expose the GSV distad to the required length of the graft. Divide the GSV distally over an applied clamp likewise and secure it towards the periphery with a simple ligature. Mark the harvested GSV segment at one end with a coronary bulldog clamp (venous valves reversed) and place it in HTK (Bretschneider) solution until further use. Once haemostasis has been achieved, close the wound in layers. Apply a dry dressing.

    Tips:

    1. Do not overstretch the harvested GSV segment, as this may result in sclerosis and stenosis in the long term.

    2. The harvested GSV segment should be flushed with heparin-saline solution and thus gently stretched (not demonstrated in the video).

  2. Posterior approach to the right popliteal artery

    Video
    Posterior approach to the right popliteal artery
    Soundsettings

    Reposition the patient to the prone position. Make a longitudinal, slightly S-shaped skin incision in the popliteal fossa and gradually divide the subcutis.

Preparation of the popliteal artery/aneurysm

Gradually divide the crural fascia and expose the popliteal artery centrad and distad of the aneury

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