The saphenous vein is exposed by an incision started in the groin 2 cm medial to the femoral pulse. Once exposed the incision is extended along the course of the saphenous vein to the distal point of anastomosis. The popliteal artery is identified at this point. The saphenous vein is divided at it junction with the common femoral vein, then elevated from its bed while branches are identified and divided. Once totally removed from the leg the vein is checked for closure of branches by irrigation.
Clamps control arterial blood flow while proximal and distal arteriotomies are made.
The vein is reversed so that an anastomosis is created with the proximal end of the vein to the distal popliteal artery. A tunneling device is passed from the groin to the popliteal fossa through the fascial plane deep to sartorius muscle. The vein is attached to the tunneler and with the removal of the tunneler the vein is passed through the fascial plane to the groin region. An anastomosis is created with the vein and the common femoral artery. Once completed blood flow is returned and checked with Doppler.