Reoperative vascular surgical procedures play an important role in the successful salvage of ischemic limbs. Such secondary procedures frequently involve difficult situation where the surgical incisions and the vascular anatomy have been compromised by infection of prior surgery. In such instances an alternative surgical approach may provide a significant advantage and aid in successful revascularization. Use of the posterior approach in reoperative vascular surgery is unusual. The application of this exposure may facilitate selected secondary surgical procedures. We review the use of the posterior approach to the popliteal vessels in three patients who required reoperative vascular reconstruction. These cases illustrate the judicious application of this technique and the resultant benefit of this unusual surgical approach.