In patients with diabetes, a popliteocrural vein bypass frequently must be linked to the distal peroneal artery. To reduce trauma to the ischemically damaged tissue, we used a dorsal approach to the peroneal artery. With the patient prone, a incision parallel to the posterolateral margin of the Achilles tendon is made. After the deep crural fascia and flexor hallucis longus are split, access to the peroneal artery is easily obtained. The second segment of the popliteal artery is exposed in the popliteal cavity. The small saphenous vein is left in situ and anastomosed with the arteries after proximal and distal preparation and valvulotomy.

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