Popliteal artery aneurysm: Resection and revascularization with greater saphenous vein graft (posterior access)

Start the longitudinal skin incision where the greater saphenous vein (GSV) terminates in the femoral vein. Expose the saphenofemoral junction (SFJ) step by step and divide its branches between ligatures. Clamp the GSV just distal to where it terminates in the deep femoral vein and secure the central stump with a suture ligature. Expose the GSV distad to the required length of the graft. Clamp and divide the GSV distally and secure the distal stump 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 hemostasis has been achieved close the wound in layers. Apply a dry dressing.

Tips:

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

2. Flush the harvested GSV segment with heparin-saline and thus gently stretch it (not demonstrated in the video).

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

Gradually divide the crural fascia and expose the popliteal artery centrad and distad of the aneurysm in the P II/III segment. Loop the popliteal artery centrad with a vessel loop as torniquet and continue the dissection. Divide any crossing veins and collateral branches of the aneurysm between ligatures. Loop the popliteal artery distad with a vessel loop.

After systemic administration of 5000 IU heparin and waiting out the perfusion time, clamp the popliteal artery centrad and distad of the aneurysm. First, divide the artery centrad of the aneurysm. Mobilize the aneurysm, which is completely resected once the popliteal artery has been divided.

Tip:

In case of marked adhesions of the aneurysm with the surrounding tissue, express the aneurysm after clamping and gather it together with a running suture. Follow this by bridging the aneurysm left in situ with the graft.