Arterial Supply Lower Limb

Femoral Artery

 

Enters thigh

- midway between ASIS and pubic symphysis

- in femoral triangle

- NAVY (nerve / artery / vein / Y fronts)

- in femoral sheath with femoral vein (transversalis fascia and psoas fascia)

- femoral nerve outside sheath / under the iliac fascia / lateral

 

Femoral triangle

 

Anatomy

- inguinal ligament superiorly

- medial border sartorius laterally

- adductor longus medially

- floor is iliopsoas, pectineus and adductor longus

 

Femoral vein

- enters thigh posterior to femoral artery

- comes to lie medially

- receives great saphenous vein anteromedially

- in femoral triangle / just below femoral sheath

 

Femoral artery

- 4 branches under inguinal ligament

- superficial circumflex iliac

- superficial epigastric

- superficial and deep external pudenal

 

Enters adductor canal / subsartorial canal

 

Anatomy

-sartorius is roof

- floor is longus then magnus

- contents artery, vein and saphenous nerve

- vein comes to lie posterolateral

- artery always between vein and nerve

 

Saphenous nerve

- exits between sartorius and gracilis

- pierces fascia

- runs with great saphenous vein

 

Surgical approach

- medial thigh incision

- reflect sartorius medially

- divide fascial roof

 

Profunda femoris

 

Angiogram Proximal Femur0001Angiogram Proximal Femur0002

 

Artery to thigh muscles

- exits laterally at termination of femoral sheath

- 3-4 cm distal to inguinal ligament

- arises from lateral side

- passes between pectineus and add longus

- runs behind longus

- runs down on adductor brevis and magnus

- gives 4 perforating branches

 

Perforators

- pass backwards through adductor magnus

- one above, second through, third and fourth below adductor brevis

 

Lateral circumflex

- lateral side of profunda

- passes laterally between branches of femoral nerve

- under sartorius and rectus

 

A.  Ascending branch

- runs up between sartorius and TFL

- on vastus lateralis

- must be ligated in Smith Petersen approach

- supplies trochanteric anastomosis

- ends ASIS

 

B.  Transverse branch

- passes across v. lateralis to wrap around proximal femur and supply cruciate anastomosis

 

C.  Descending branch

- descends in groove between v. lateralis and intermedius

- travels with nerve to v. intermedius

 

Medial circumflex

 

Arises

- medial side profunda

- passes backwards between pectineus and psoas

- runs to back of femoral neck

 

Deep branch

- runs along inferior border of obturator externus

- emerges between obturator externus and quadratus femoris

- then runs over tendons of conjoint and piriformis

- supplys femoral head via posterior and superior femoral neck branches

 

Other branches

- anterior / posterior / transverse and trochanteric

 

Popliteal fossa

 

Boundaries

Superior: biceps laterally with semitendinosis / semimembranosus medially

Inferior: medial and lateral gastrocnemius

Floor: knee joint and capsule, popliteus

 

Popliteal artery

 

Popliteal arterty illustrationPosterior approach knee

 

Anatomy

- deepest structure throughout

- enters deep and medial

- medial to femur via adductor hiatus

- bows laterally

- exits posterolateral to tibial nerve under fibrous arch of soleus

- returns to medial side

 

Popliteal vein

- always between artery and nerve

 

Divisions

- lower border of popliteus

- usually into anterior and posterior tibial artery (gives peroneal as a branch)

- sometimes into anterior and peroneal artery (

- sometimes into anterior / posterior and peroneal artery

 

Posterior Tibial Artery

 

Relations leg

- runs down on tibialis posterior behind deep intermuscular septum

- travels with tibial nerve

- at times between FHL and FDL

- gastronemius and soleus superficial

- gives peroneal artery as a branch

 

Relations ankle

- runs back of tibia and ankle joint to tarsal tunnel

- runs in groove behind medial malleolus between T posterior and FDL with tibial nerve

- passes deep to abductor hallucis and divides into medial and lateral plantar arteries

- found between first and second layer of the foot

- lateral plantar forms plantar arch by uniting with deep branch of the dorsalis pedis

 

Peroneal Artery

 

Origin

- usually branch of posterior tibial

- 2.5 cm below popliteus

 

Relations

- runs along medial aspect fibula

- between FHL and T posterior

 

Anterior Tibial Artery

 

Origin

- lower border of popliteus

 

Relations leg

- passes between two heads T posterior

- passes through aperature of interosseous membrane

- descends on interosseous membrane

- initially between T anterior and EDL

- eventually is crossed by EHL and crosses ankle between EHL and EDL

- runs with the deep peroneal nerve

- becomes dorsalis pedis under extensor retinaculum

- runs to interval between 1st and second MT