Matthew T. Allemang and Vikram S. Kashyap

Introduction

Exposure of the popliteal artery and vein is relevant to many surgical specialties, including general, vascular, and trauma. The approach to the popliteal anatomy can be dictated by the pathology, with specific conditions unique to this mobile area. Thus, this chapter encompasses both medial and posterior approaches to the popliteal artery and vein. Causes of popliteal artery disease include atherosclerosis, aneurysm, trauma (pseudoaneurysm, dissection, rupture), popliteal entrapment syndrome, and cystic adventitial disease. Although less common, venous pathology usually encompasses trauma, aneurysm, and entrapment as well. Treatment of each is largely determined by the anatomic location, and therefore knowledge of basic anatomy and relevant landmarks is critical.

Surgical Principles

The popliteal artery begins at the adductor canal within the adductor magnus muscle (Hunter’s canal) as it enters the popliteal space behind the knee joint. The popliteal artery ends when it splits in the lower leg to become the anterior tibial artery and tibioperoneal trunk. Several important geniculate collaterals increase in caliber in cases of progressive atherosclerotic occlusion of the distal superficial femoral and popliteal arteries (Fig. 38-1, A). If an acute occlusion is present in this area, however, the collateral vessels are not sufficient and the leg is usually threatened, requiring immediate revascularization. Venous anatomy, on the other hand, is more variable.

Medial Suprageniculate Approach

The medial suprageniculate approach is most often used in femoral-to-popliteal artery (femoropopliteal) bypass above the knee. The patient is placed in the supine position with the knee slightly flexed. An incision is made on the distal portion of the medial thigh over the estimated location of the sartorius muscle (Fig. 38-1, B).

After locating the junction between the sartorius (posterior) and vastus medialis (anterior), the surgeon places a self-retaining retractor there (Fig. 38-2).