If there is knowledge via prior ultrasound or arteriogram that the common femoral and profunda femoris are not involved, the SFA may be approached below the common femoral bifurcation through a small incision avoiding the groin crease and lymph node basin.
In the more typical case, the optimal approach exposes the bifurcation of the common femoral artery. If ultrasound is available and the bifurcation can be localized, a small transverse incision can be placed just over that location to facilitate wound healing without impairing exposure. If the vessel is heavily diseased and local endarterectomy or patch angioplasty is a possibility, then strong consideration to a longitudinal arteriotomy is considered.
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