Arteries of the Lower Extremity



Arteries of the Lower Extremity





The common femoral artery is the continuation of the external iliac artery. It begins at the level of the inguinal ligament and ends when it originates the arteria profunda femoris. The continuation of the common femoral artery is then called the superficial femoral artery. The superficial femoral artery extends down the leg, where it passes through the adductor canal originating the popliteal artery (Figs. 22.1, 22.2, 22.3).

Knowledge of the vascular anatomy of the vessels in the groin and the relationship of the vessels with the femoral nerve is relevant for the current practice of medicine. Access to the arterial vascular system, including the abdominal aorta and the thoracic aorta and branches is mostly through femoral artery puncture. The femoral nerve (most lateral), the common femoral artery (in the center), and the common femoral vein (most medial) have a constant relationship when they pass under the inguinal ligament and reach the inguinal compartment, surrounded by muscles forming a bundle (Fig. 22.2). The common femoral artery is best palpated in the deepest fossa at the level of the inguinal crease.


Common Femoral Artery


Intravascular ultrasound of the common femoral artery

Intravascular Ultrasound (IVUS) of a large artery such as the femoral artery shows the arterial wall structure in three layers: an inner echogenic layer, a middle hypoechoic layer, and an outer echogenic layer, histopathologically corresponding to the tunica intima, the tunica media, and the tunica adventitia. Next to the artery the femoral vein can be seen with a larger diameter and less well-defined layers (Fig. 22.4).

Branches



  • Superficial epigastric artery


  • Superficial circumflex iliac artery


  • Superficial external pudendal artery


  • Deep external pudendal artery


  • Arteria profunda femoris


  • Superficial femoral artery


  • Muscular branches


  • Descending genicular arteries


Superficial Epigastric Artery

This artery arises about 1 cm below the inguinal ligament and anastomoses with branches of the inferior epigastric artery and the opposite vessels (See Chapter 19, Fig. 19.1).


Superficial Circumflex Iliac Artery (Fig. 22.5)
Superficial External Pudendal Artery (Fig. 22.5)
Deep External Pudendal Artery (Fig. 22.5)
Muscular Branches
Arteria Profunda Femoris (Fig. 22.6)

It is the largest branch of the femoral artery, with an origin about 3.5 cm from the inguinal ligament. It arises laterally and posteriorly from the femoral artery (Figs. 22.7, 22.8, 22.9, 22.10, 22.11, 22.12, 22.13, 22.14).

Branches



  • Lateral circumflex femoral artery



    • Ascending branch


    • Descending branch


  • Medial circumflex femoral artery


  • Perforating arteries. There are usually three (Fig. 22.7)



    • First perforating artery


    • Second perforating artery



      • Femoral nutrient artery


    • Third perforating artery



  • The end of the arteria profunda femoris is called the fourth perforating—numerous muscular branches are present at that level


  • Anastomoses



    • Gluteal arteries—with terminal branches of the medial circumflex femoral artery


    • Circumflex femoral arteries—with first perforating artery


    • Perforating arteries—communicating with each other


    • Fourth perforating artery—with superior muscular branches of popliteal arteries


Descending Genicular Artery (Figs. 22.1, 22.15)

This artery branches from the superficial femoral artery before the adductor’s canal and anastomoses with the medial superior genicular artery.

Branches



  • Saphenous branch—anastomoses with medial inferior genicular artery


  • Muscular branches, articular branches


Popliteal Artery

The popliteal artery is the continuation of the superficial femoral artery passing the adductor’s canal, continuing until branching into anterior and posterior tibial arteries (Figs. 22.15, 22.16, 22.17).

Branches



  • Cutaneous branches


  • Superior muscular branches


  • Sural arteries


  • Superior genicular arteries


  • Middle genicular artery


  • Inferior genicular arteries

Cutaneous Branches


Superior Muscular Branches (Figs. 22.18, 22.19)

Two or three branches


Sural Arteries (Figs. 22.16, 22.20)

Two arteries as a rule


Superior Genicular Arteries (Figs. 22.15, 22.16, 22.18, 22.21)

Branches



  • Medial superior genicular artery



    • Anastomoses with descending genicular artery and medial inferior genicular artery


  • Lateral superior genicular artery



    • Anastomoses with the descending lateral circumflex, with the lateral inferior genicular artery, descending genicular artery, and medial superior genicular artery


Middle Genicular Artery (Figs. 22.15, 22.16, 22.18, 22.21)

This artery is small and not always recognizable.


Inferior Genicular Arteries (Figs. 22.15, 22.16, 22.18, 22.21, 22.22)

Branches



  • Medial inferior genicular artery



    • Anastomoses with the lateral inferior genicular artery, the medial superior genicular artery, the anterior tibial recurrent artery and the saphenous branch, and the descending genicular artery.


  • Lateral inferior genicular artery



    • Anastomoses with the medial inferior genicular artery, the lateral superior genicular artery, and anterior and posterior tibial recurrent circumflex peroneal arteries.


Genicular Anastomosis (Figs. 22.15, 22.22)


Superficial Network



  • Fascia


  • Skin


  • Fat


Deep Network



  • Articular surface


  • Bone


  • Marrow


  • Capsule


  • Synovial membrane

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Jun 15, 2016 | Posted by in ANATOMY | Comments Off on Arteries of the Lower Extremity

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