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The distal popliteal artery is exposed immediately posterior to the tibia by opening the fascial compartment and retracting the gastrocnemius and soleus muscles posteriorly and the adductor muscles anteriorly. Insertion of a self-retaining retractor greatly facilitates the exposure as does a Richardson retractor proximally (Figure 9). The popliteal artery is identified medial to the posterior tibial nerve and the popliteal vein. Often, the popliteal vein must be mobilized in order to get to the more lateral artery. It is carefully dissected free over a distance of 4 to 5 cm (Figure 10), controlling any small tributaries with double loops of 00 silk (Potts ties). Vessel loops are then passed around the vessel proximally and distally to elevate the vessel and improve exposure (Figure 11). The proximal popliteal space then is entered by incising the fascia anterior to the sartorius muscle, and the proposed graft tunnel is developed by blunt finger dissection (Figure 12) or a tunneling instrument. This instrument is particularly useful if the saphenous vein is harvested through multiple incisions rather than the long continuous one illustrated in the preceding Plate 162.

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