We report the case of a 65-year-old man with critical limb ischemia treated with popliteal-peroneal bypass via the posterior approach and endarterectomy of the P2 popliteal artery. The posterior approach is useful in a number of situations, such as cases of arteriosclerotic disease of the crural arteries, where the target artery is the distal posterior tibial artery or peroneal artery; where the inflow site is the popliteal artery; in cases of a poor-quality greater saphenous vein, limited length of vein, and a preferable lesser saphenous vein; and in reoperation after failed bypass via a medial approach. Vascular surgeons should consider the posterior approach as an alternative procedure in below-knee revascularization.
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