The work of the peripheral vascular surgeon ranges widely through the anatomy of the whole body and he is required to command a wide range of anatomical knowledge.Both diseased and healthy arteries may be surprisingly friable, and rough dissection may cause severe damage and be sufficient to jeopardize the result of the vascular reconstruction. This power point presentation outlines the different exposure techniques to almost all vessels in the body which makes the surgeon familiar and confident when faced with a clinical situation that mandates exposure of certain vessel whether as an emergency or elective procedure.

1. WWEELLCCOOMM
EE

2. EEXXPPOOSSUURREE OOFF MMAAJJOORR
BBLLOOOODD VVEESSSSEELLSS
PPrrooffeessssoorr
AAbbdduullssaallaamm YY TTaahhaa
22001144
School of Medicine
Faculty of Medical Sciences
University of Sulaimani
Sulaimani
Region of Kurdistan
Iraq
https://sulaimaniu.academia.edu/AbdulsalamTaha

3. IINNTTRROODDUUCCTTIIOONN
 TThhee wwoorrkk ooff tthhee ppeerriipphheerraall vvaassccuullaarr
ssuurrggeeoonn rraannggeess wwiiddeellyy tthhrroouugghh tthhee
aannaattoommyy ooff tthhee wwhhoollee bbooddyy aanndd hhee iiss
rreeqquuiirreedd ttoo ccoommmmaanndd aa wwiiddee rraannggee ooff
aannaattoommiiccaall kknnoowwlleeddggee.
 BBootthh ddiisseeaasseedd aanndd hheeaalltthhyy aarrtteerriieess mmaayy
bbee ssuurrpprriissiinnggllyy ffrriiaabbllee,, aanndd rroouugghh
ddiisssseeccttiioonn mmaayy ccaauussee sseevveerree ddaammaaggee aanndd
bbee ssuuffffiicciieenntt ttoo jjeeooppaarrddiizzee tthhee rreessuulltt ooff tthhee
vvaassccuullaarr rreeccoonnssttrruuccttiioonn.

4. EExxppoossuurree ooff CCaarroottiidd AArrtteerryy
 TThhee iinncciissiioonn iiss ppllaacceedd
aalloonngg tthhee aanntteerriioorr ppaarrtt
ooff
sstteerrnnoocclleeiiddoommaassttooiidd
mmuussccllee aass ffaarr aass tthhee
aannggllee ooff tthhee jjaaww aanndd
ppaasssseess sslliigghhttllyy
bbaacckkwwaarrddss.

5. ..EExxppoossuurree ooff ccaarroottiidd aarrtteerryy
 AAfftteerr iinncciissiinngg tthhee sskkiinn
aanndd ppaallttyyssmmaa,, tthhee
SSCCMM mmuussccllee iiss
ddiissppllaacceedd ppoosstteerriioorrllyy
aanndd tthhee IIJJVV ccoommeess
iinnttoo vviieeww. TThhee aanntteerriioorr
ffaacciiaall vveeiinn ccaann bbee
sseeeenn ppaassssiinngg
ffoorrwwaarrddss.

6.  TThhee aanntteerriioorr ffaacciiaall
vveeiinn iiss ddiivviiddeedd aanndd
tthhee IIJJVV iiss rreettrraacctteedd
ppoosstteerriioorrllyy eexxppoossiinngg
tthhee CCCCAA ccoovveerreedd wwiitthh
aa llaayyeerr ooff aarreeoollaarr
ttiissssuuee.

7.  By dissecting aalloonngg tthhee mmeeddiiaall
bboorrddeerr ooff tthhee CCCCAA tthhee ssuuppeerriioorr
tthhyyrrooiidd aarrtt wwiillll bbee sseeeenn aanndd ccaann
bbee eenncciirrcclleedd wwiitthh aa sslliinngg. TThhee
EECCAA ccaann aallssoo bbee ccoonnttrroolllleedd iinn
tthhee ssaammee wwaayy,, ccaarree bbeeiinngg
ttaakkeenn ttoo llooccaattee tthhee hhyyppoogglloossssaall
nn aass iitt ccrroosssseess tthhee vveesssseellss
hhiigghh uupp iinn tthhee wwoouunndd.
 TThhee IIJJVV iiss rreettrraacctteedd ppoosstteerriioorrllyy
aanndd tthhee vvaagguuss nn wwiillll bbee sseeeenn
bbeettwweeeenn tthheessee 22 vveesssseellss.
 TThhee ddeesscceennddiinngg hhyyppoogglloossssaall nn
rruunnss ddoowwnn tthhee ffrroonntt ooff tthhee
CCCCAA.
 TThhee sslliinnggss aarroouunndd tthhee ssuuppeerriioorr
tthhyyrrooiidd aanndd EECCAA ccaann bbee uusseedd
ffoorr rreettrraaccttiioonn ttoo eexxppoossee tthhee
IICCAA mmoorree ffuullllyy.

8.  IIff iitt pprroovveess nneecceessssaarryy
ffoorr mmoorree ooff tthhee IICCAA ttoo
bbee eexxppoosseedd tthheenn tthhee
ssttyylloohhooiidd mm sshhoouulldd bbee
ddiivviiddeedd.
 MMoorree ooff tthhee IICCAA ccaann
bbee eexxppoosseedd bbyy
ddiivviissiioonn ooff tthhee
ddiiggaassttrriicc tteennddoonn oorr
ssuubblluuxxaattiioonn ooff tthhee jjaaww
iinn aa ffoorrwwaarrdd ddiirreeccttiioonn.

9. EExxppoossuurree ooff vveerrtteebbrraall aarrtteerryy
An incision is made obliquely
just lateral to the SCM
The IJV is exposed after
dividing the lateral
.part of this muscle

10.  TThhee IIJJVV iiss rreettrraacctteedd
llaatteerraallllyy ttoo eexxppoossee tthhee
vvaagguuss nn wwhhiicchh iiss aallssoo
rreettrraacctteedd llaatteerraallllyy.
 TThhee ccaarroottiidd aarrtt wwiillll bbee
sseeeenn mmeeddiiaallllyy aanndd tthhiiss
sshhoouulldd bbee ddiisssseecctteedd
ssuuffffiicciieennttllyy ttoo aallllooww
mmeeddiiaall rreettrraaccttiioonn.
 DDiisssseeccttiioonn iinn tthhee aannggllee
bbeettwweeeenn tthhee aarrtteerryy aanndd
vveeiinn rreevveeaallss tthhee vveerrtteebbrraall
vveeiinn aanndd bbeehhiinndd iitt tthhee
vveerrtteebbrraall aarrtt ccrriissssccrroosssseedd
bbyy bbrraanncchheess ooff tthhee
cceerrvviiccaall ssyymmppaatthheettiicc
cchhaaiinn.

11.  TThhee vveerrtteebbrraall vv aanndd
ssoommee eelleemmeennttss ooff tthhee
ssyymmppaatthheettiicc ttrruunnkk aarree
ddiivviiddeedd wwiitthh
ddoowwnnwwaarrdd eexxtteennssiioonn
ooff tthhee iinncciissiioonn ttoo
eexxppoossee tthhee lloowweerr ppaarrtt
ooff tthhee vveerrtteebbrraall aarrtt
bbeeffoorree iitt ppaasssseess
ttoowwaarrddss tthhee vveerrtteebbrraall
bbooddiieess aanndd aallssoo ttoo
eexxppoossee tthhee
ssuubbccllaavviiaann aarrtteerryy ffrroomm
wwhhiicchh iitt aarriisseess.

12.  For exposure ooff tthhee ddiissttaall
vveerrtteebbrraall aarrtt ,, aann iinncciissiioonn
sshhoouulldd aallssoo bbee mmaaddee aalloonngg tthhee
lliinnee ooff SSCCMM,, wwhhiicchh aafftteerr
eexxppoossuurree iiss rreettrraacctteedd mmeeddiiaallllyy.
 TThhee ddiisssseeccttiioonn sshhoouulldd pprroocceeeedd
ppoosstteerriioorrllyy,, tthhee CCAA aanndd vveeiinn
bbeeiinngg rreettrraacctteedd mmeeddiiaallllyy iiff
nneecceessssaarryy.
 TThhee aacccceessssoorryy nn wwiillll bbee ffoouunndd
ccrroossssiinngg tthhee lleevvaattoorr ssccaappuullaaee
mm ,, tthhee uuppppeerr ppaarrtt ooff tthhiiss
mmuussccllee sshhoouulldd bbee ddiivviiddeedd wwiitthh
aa ssccaallppeell ppaassssiinngg aann
aapppprroopprriiaattee iinnssttrruummeenntt bbeehhiinndd
iitt ttoo pprrootteecctt tthhee ssttrruuccttuurreess llyyiinngg
tthheerree.

13.  WWhheenn tthhee lleevvaattoorr
ssccaappuullaaee mm hhaass bbeeeenn
ddiivviiddeedd tthhee aanntteerriioorr
pprriimmaarryy rraammuuss ooff CC22
wwiillll bbee sseeeenn ccrroossssiinngg
tthhee cceerrvviiccaall ppaarrtt ooff tthhee
aarrtteerryy.
 FFuurrtthheerr aacccceessss ttoo tthhee
aarrtteerryy ccaann bbee
oobbttaaiinneedd bbyy ddiivviiddiinngg
CC22.

14. EExxppoossuurree ooff ssuubbccllaavviiaann aarrtteerryy
An incision is made lateral
.to the insertion of SCM
The platysma and facia
are dissected to reveal
the omohyoid m, lymph
nodes and fat. The lymph
nodes and fat should be
.displaced upwards

15. The phrenic n
will be seen beneath
the deep facia overlying
the anterior SM which
can be felt as a band passing
.downward and medially
The brachial plexus will
. be seen or felt laterally
A curved blunt instrument is
.Passed behind the ant SM
The anterior SM
is divided carefully
protecting the phrenic
nerve which is best
performed by passing
.a sling around it

16. DDiivviissiioonn ooff tthhee aanntt
SSMM rreevveeaallss tthhee
ssuubbccllaavviiaann aarrtteerryy
aanndd iittss
ssuupprraassccaappuullaarr aanndd
iinntteerrnnaall mmaammmmaarryy
bbrraanncchheess. TThhee
vveerrtteebbrraall aarrtteerryy ccaann
aallssoo bbee sseeeenn
..mmeeddiiaallllyy

17. EExxppoossuurree ooff tthhee ddiissttaall ssuubbccllaavviiaann aanndd
pprrooxxiimmaall aaxxiillllaarryy aarrtteerryy
The subclavian artery should
be exposed as aleardy
described, the incision
being taken across the
clavicle. This can be divided
.as shown
After division of the clavicle
downward retraction reveals
the distal part of the subclavian
art as it crosses the 1st rib and
the upper part of the axillary a
.beyond this

18. EExxppoossuurree ooff aaxxiillllaarryy aarrtteerryy
The middle part of the
axillary artery is exposed by
making an incision below
the middle third of the
. clavicle
The skin and deep facia are
incised and branches of the
acromioclavicular a can be
seen coming through the
clavipectoral facia. The pectoralis
major m lies above and below
.these branches

19. The muscle fibers of the PMM
are divided after tying off the
branches of the acromioclavicular
artery. The axillary a can be felt
in the depth of the wound and
.exposed by sharp dissection
One or two branches need to
.be tied to expose it fully
For more distal exposure
the pectoralis minor m
in the lateral part of the
wound needs to be divided
completely. Retraction is required
.to access the artery

20. RELAX

21. EExxppoossuurree ooff bbrraacchhiiaall aarrtteerryy
This can be exposed
throught the upper
arm by an incision
placed along its medial
border just behind the
.biceps muscle
After incising the skin and deep
facia the biceps muscle is retacted
.anteriorly and the triceps posteriorly
The median nerve can be seen lying
.superiorly to the brachial artery

22. Further dissection will reveal
the brachial vein which can
be retracted posteriorly to
.expose the ulnar nerve
For exposure
of the
bifurcation
of the
brachial artery
an S-shaped
incision should
be made in the
antecubital
.fossa

23. AAfftteerr ddiivviissiioonn ooff tthhee 
bbiicciippiittaall aappppoonneeuurroossiiss 
tthhee bbrraacchhiiaall aarrtteerryy aanndd iittss 
bbiiffuurrccaattiioonn iinnttoo tthhee rraaddiiaall aanndd
uullnnaarr aarrtteerriieess wwiillll bbee sseeeenn
wwhheerree tthheeyy ppaassss bbeettwweeeenn tthhee
bbrraacchhiioorraaddiiaalliiss aanndd fflleexxoorr
mmuusscclleess.. TThhee mmeeddiiaann nn aanndd
bbaassiilliicc vv ccaann bbee sseeeenn
..ppoosstteerroommeeddiiaall ttoo tthhee aarrtteerryy

24. ..EExxppoossuurree ooff uullnnaarr aanndd rraaddiiaall aarrtteerriieess
The incisions
are made on
the anterior
surface of
.the forearm
By dissection
between the
brachioradialis m
medially and the
flexor carpi radialis
m laterally the radial
artery will be
exposed along with
its associated
.veins

25. By
dissection
of the
pronator teres
and
brachioradialis
m laterally
and the
flexor
digitorum
sublimis m
medially the
ulnar artery
.will be seen
For exposure
of the ulnar
and radial artery
at the wrist the
incisions should
be made as
.indicated

26. The
radial
artery is
very
superficial
and
can be
palpated
and
exposed
.easily
The ulnar
artery is a
little deeper
but again is
relatively
superficial
and can be
exposed
before it enters
the deep
aspect of
the
hypothenar
.muscle

28. Exposure ooff tthhee aasscceennddiinngg aaoorrttaa
aanndd aarrcchh bbrraanncchheess
Various incisions are made
to expose the AA and its
branches in the neck. The most
.commonly used is a vertical incision
A vertical incision@
from suprasternal
notch to
.xiphisternum
an electrical@
.saw can be used
or a long@
Robert's clamp
and a Gigli saw
are used to divide
.the sternum

29. after the sternum@
has been divided it is
held apart by self-retaining
.retracter
the brachiocephalic v will@
be seen and should be retracted
downwards to expose the aortic
arch and the roots of the major
.vessels

30. In order to expose the@
branches of the aortic arch
in the neck a transverse limb
.is added to the vertical incision
By division of the SCM@
and anterior SM, the subclavian
art can be seen and the phrenic
N protected. This allows various
types of graft to be inserted
between the AA & its branches
.in the neck

31. EExxppoossuurree ooff tthhee ddeesscceennddiinngg tthhoorraacciicc
aaoorrttaa
This is exposed through
an incision in the 5th or
, 8th inter-costal space
depending upon which
. level is to be exposed
The thoracic cavity is entered
by removing the rib and the lung
displaced forwards. The descending
.aorta will be seen posteriorly

32. Exposure ooff tthhee lloowweerr tthhoorraacciicc aanndd uuppppeerr
aabbddoommiinnaall aaoorrttaa
A midline incision is made in the
abdomen with an extension through
the costal margin along the 7th rib
for exposure of lower thoracic aorta
and the 5th for exposure of the
.upper thoracic aorta
The rectus muscle and costal
margin are divided to allow exposure
.of the pleura which is then opened

33. The diaphragm can be divided
either transversely close to the
costal margin which avoids damage
to the phrenic n, or vertically which
damages the phrenic n but gives
.much better exposure
After division of the diaphragm
the thoracic aorta, liver, abdominal
.contents and spleen can be seen

34. An incision is made in
the peritoneum along
the lateral border of the
.spleen and colon
The colon, spleen and pancreas are
mobilized to the right which exposes
the AA and its main branches; the coeliac
.axis, the SMA and the renal vessels
The left renal vein can be seen
.crossing the AA

35. Exposure of AAAA aanndd iittss bbrraanncchheess
A: transverse incisions
B: vertical incisions
.C: oblique incisions
SMA
The peritoneum on the left side of the
DJ flexure is incised carefully and the
bowel pushed to the right. This will
.expose the aorta

36. EExxppoossuurree ooff SSMMAA EExxppoossuurree ooff AAAA
Alternatively a transverse
abdominal incision can be used
with the same incision in the
peritoneum close to the DJ flexure
.in order to expose the aorta
For retroperitoneal exposure the
abdominal muscles are divided
and the peritoneum displaced to
right. This will expose the aorta
.and the Kidney

37. EExxppoossuurree ooff ccooeelliiaacc aaxxiiss
The coeliac axis
is exposed after
opening the abdomen
through
a transverse
or vertical
incision and opening
.the lesser omentum
After opening
,the lesser sac
the aorta is felt
where the crura
.cross it
The crura are
divided to
expose the aorta
and just above
the stomach, the
origin of the
coeliac axis
.will be seen

38. EExxppoossuurree ooff sspplleenniicc aarrtteerryy
The splenic artery is exposed
by dividing the greater omentum
along the lower border of the
stomach and displacing the
.organ medially
The artery will be seen running
along the upper part of the
.pancreas

39. EExxppoossuurree ooff SSMMAA oorriiggiinn
An incision in the
peritoneum lateral
to the colon and
.spleen
The spleen, pancreas and stomach
are mobilized to the right exposing
the kidney, the aorta and its major
branches and the renal veins. The origins
of the coeliac axis and SMA and other branches
.can be accessed in this way

40. EExxppoossuurree ooff SSMMAA
FFoorr eexxppoossuurree ooff tthhee
SSMMAA lloowweerr ddoowwnn tthhee
iinntteessttiinnee iiss mmoobbiilliizzeedd
ttoo tthhee rriigghhtt aanndd tthhee
aarrtteerryy,, aalloonngg wwiitthh
tthhee SSMMVV ppaallppaatteedd iinn
tthhee ffrreeee eeddggee ooff tthhee
mmeesseenntteerryy aabboovvee
tthhee jjuujjeennuumm.. IInncciissiinngg
tthhee ppeerriittoonneeuumm wwiillll
eexxppoossee tthhee aarrtteerryy
..hheerree

41. EExxppoossuurree ooff
hheeppaattiicc aarrtteerryy
DDiivviissiioonn ooff tthhee lleesssseerr
oommeennttuumm aalllloowwss
eexxppoossuurree ooff tthhee
hheeppaattiicc aarrtteerryy aass iitt
ccrroosssseess ffrroomm tthhee
..ccooeelliiaacc aarrtteerryy

42. EExxppoossuurree ooff
rreennaall aarrtteerriieess
TThhee rreennaall aarrtteerriieess
aarree eexxppoosseedd uussiinngg aa
ttrraannssvveerrssee oorr
vveerrttiiccaall iinncciissiioonn aafftteerr
ppaassssiinngg aa sslliinngg
aarroouunndd tthhee lleefftt rreennaall
vveeiinn wwhhiicchh iiss ppuulllleedd
..ddoowwnnwwaarrddss

43. The right renal aa iiss eexxppoosseedd bbyy iinncciissiinngg tthhee
ppeerriittoonneeuumm llaatteerraall ttoo tthhee dduuooddeennaall lloooopp aanndd
..ddiissppllaacciinngg iitt mmeeddiiaallllyy

44. EExxppoossuurree ooff tthhee
iilliiaacc aarrtteerryy
AAnn oobblliiqquuee
iinncciissiioonn iiss
mmaaddee iinn
..tthhee iilliiaacc ffoossssaa

45. To expose the iliac artery and
vein the muscles are divided
and the peritoneum mobilized
medially, taking care to avoid
the ureter which crosses the
Bifurcation of the common
.Iliac artery
INTERNAL
ILIAC
ARTERY
In order to expose this vessel, the
common and external iliac arteries
are encircled with slings and pulled
laterally. This allows exposure of the
origin of the internal iliac artery which
.can be dissected free with scissors

46. EExxppoossuurree ooff tthhee IIVVCC
The IVC is exposed by opening the patient's abdomen through a transverse
or vertical incision, incising the peritoneum lateral to the duodenal loop
and ascending colon
displacing these structures medially to expose the entire vena
.cava retroperitoneally

47. EExxppoossuurree ooff tthhee
ppoorrttaall vveeiinn
TThhiiss iiss eexxppoosseedd iinn
tthhee ffrreeee eeddggee ooff tthhee
PPoorrttaa hheeppaattiiss.. TThhee
hheeppaattiicc aarrtteerryy iiss
mmoobbiilliizzeedd mmeeddiiaallllyy
aanndd tthhee bbiillee dduucctt
lliikkeewwiissee.. TThhee ppoorrttaall
vveeiinn lliieess bbeehhiinndd
..tthheessee vveesssseellss

48. Exposure ooff tthhee SSpplleenniicc vveeiinn
As this structure lies behind
the pancreas it is best exposed
by incising the peritoneum
.lateral to the spleen
The spleen is then mobilized
medially and the vein will be seen
running along the back of the pancreas
.where it can be isolated if necessary

50. Exposure of the superficial and ddeeeepp ffeemmoorraall aarrtteerriieess
A vertical
or oblique
incision
is made
.in the groin
The
facia
overlying
the vessels
is cut
with
a pair
.of scissors

51. A pair of Lahey
forceps is passed
behind the artery
and a sling passed
.behind it
Slings are similarly
passed around the
common and SFA and the
upper branches of the deep
.femoral arteries

52. EExxppoossuurree ooff ddeeeepp
FFAA
ffoorr eexxtteennssiivvee
eexxppoossuurree ooff tthhee
ddeeeepp ffeemmoorraall aarrtteerryy
tthhee ssmmaallll vveeiinnss
wwhhiicchh oofftteenn ccrroossss iittss
oorriiggiinn aanndd lloowweerr
ddoowwnn tthhee cciirrccuummfflleexx
ffeemmoorraall vveeiinn aarree
ddiivviiddeedd aanndd tthhee
..vveesssseell ffuullllyy eexxppoosseedd

53. EExxppoossuurree ooff tthhee SSFFAA
A vertical
incision
is made
in the
mid thigh
The vastus
medalis
and
adductor longus
muscles are
separated and
the artery
.exposed

54. EExxppoossuurree ooff tthhee PPoopplliitteeaall aarrtteerryy
A posterior S-shaped
.incision
When the facia and fat have been divided
the short saphenous vein will be seen. This
has to be divided to gain access to the popliteal
.fossa

55. TThhee mmeeddiiaall
ppoopplliitteeaall
nneerrvvee aanndd
vveesssseellss wwiillll
bbee sseeeenn ppaassssiinngg
bbeettwweeeenn tthhee ttwwoo
hheeaaddss
ooff ggaassttrrooccnneemmiiuuss
mmuussccllee aanndd aarree
ssuurrpprriissiinnggllyy
..ssuuppeerrffiicciiaall

56. For exposure of the above
knee popliteal artery an
incision is made in the lower
medial part of the thigh along
the anterior border of the
.sartorius muscle
The incision is deepened until
the long saphenous vein can be seen
and should be protected. An incision is
made in the deep facia behind the vein
and the sartorius muscle retracted
.posteriorly

57. AAbboovvee kknneeee ppoopplliitteeaall aarrtteerryy
Using finger dissection the
popliteal artery is felt in the
popliteal fossa lying anteriorly
.medial to the vein
Appropriate retraction
allows a sling to be passed
.around it to provide access

58. TThhee bbeellooww kknneeee ppoopplliitteeaall aarrtteerryy
The below knee popliteal
artery is exposed by using
an incision just behind the
tibia, passing backwards
and slightly near to the
.knee joint
An incision is made
in the deep facia
anterior to the
.gastrocnemius muscle

59. The gastrocnemius muscle
is retracted posteriorly and
the soleus muscle can be
seen attached to the tibia. The
vessels passing behind it can be
. felt above the popliteal fossa
By dividing the tendon of the
soleus muscle where it is attached
to the tibia, the artery and vein can
be followed downwards. The
artery in particular is crossed by
many small venous branches
.which require careful ligation

61. EExxppoossuurree ooff
lloonngg
ssaapphheennoouuss
vveeiinn
IInn oorrddeerr ttoo rreemmoovvee
tthhee lloonngg ssaapphheennoouuss
vveeiinn mmuullttiippllee
iinncciissiioonnss aarree mmaaddee
aalloonngg tthhee vveeiinn
..eexxppoosseedd

62. It is then removed by
undermining the skin
bridges. The upper end
of the vein can be found
first where it joins the
sapheno-femoral junction from
where it can be traced by
duplex ultrasonography and
.marked before surgery
The vein is then removed
through a continuous
incision. This is probably
better as it does less
.damage to the vein

63. EExxppoossuurree ooff tthhee
ccrruurraall vveesssseellss
TThhee ppoosstteerriioorr ttiibbiiaall
aanndd ppeerroonneeaall
aarrtteerriieess aarree eexxppoosseedd
bbyy ffuurrtthheerr
ddeettaacchhmmeenntt ooff tthhee
ssoolleeuuss mmuussccllee ffrroomm
tthhee ttiibbiiaa uunnttiill tthhee
ppeerroonneeaall aarrtteerryy
ddiissaappppeeaarrss tthhrroouugghh
tthhee iinntteerroosssseeoouuss
mmeemmbbrraannee hhaallff wwaayy
..ddoowwnn tthhee lleegg

64. EExxppoossuurree ooff tthhee PPeerroonneeaall aarrtteerryy
The peroneal artery.1
is exposed the lower
half of the leg by an
incision on the lateral
.side
The fibula is exposed. 2
.and a segment removed
Once the fibula is removed. 3
.the artery can be seen behind it

65. The anterior tibial artery
The anterior tibial artery
is exposed by an incision
over the anterior tibial
.muscles
By dissecting between the
muscles the artery is found
deep on the interosseous
membrane. It can usually be
located quite easily by finding
a branch and following this
.backwards

66. AAnntteerriioorr aanndd
ppoosstteerriioorr ttiibbiiaall
aarrtteerriieess aatt tthhee
aannkkllee
The incisions are
placed over the
dorsum of the foot
and over the
posterior tibial artery
behind the medial
.malleolus

67. THANK
YOU