Page 96 - untitled

AAAC42 21/5/05 10:54 AM Page 95
The femoral artery
anterior and extensor digitorum longus flank the artery throughout its
• Course: the femoral artery commences as a continuation of the ex-
course on its medial and lateral sides, respectively. Extensor hallucis
ternal iliac artery behind the inguinal ligament at the mid-inguinal point.
longus commences on the lateral side but crosses the artery to lie
In the groin the femoral vein lies immediately medial to the artery and tween the malleoli where it becomes the dorsalis pedis artery. Tibialis
both are enclosed in the femoral sheath. In contrast, the femoral nerve medial by the end of its course. The dorsalis pedis artery passes on the
lies immediately lateral to the femoral sheath. The femoral artery dorsum of the foot to the level of the base of the metatarsals and then
descends the thigh to pass under sartorius and then through the adductor between the two heads of the first dorsal interosseous muscle to gain
(Hunter’s) canal to become the popliteal artery. access to the sole and complete the deep plantar arch. Prior to passing to
• Branches: the sole it gives off the 1st dorsal metatarsal branch and via an arcuate
• Branches in the upper part of the femoral triangleafour branch the three remaining dorsal metatarsal branches (Fig. 42.1).
branches are given off which supply the superficial tissues of the • Branches of the anterior tibial artery include: muscular and
lower abdominal wall and perineum (see Fig. 44.1). malleolar branches.
• Profunda femorisaarises from the lateral side of the femoral
artery 4 cm below the inguinal ligament. Near its origin it gives rise The posterior tibial artery
to medial and lateral circumflex femoral branches. These con- • Course: the posterior tibial artery arises as a terminal branch of the
tribute to the trochanteric and cruciate anastomoses (see below). popliteal artery. It is accompanied by its venae comitantes and supplies
The profunda descends deep to adductor longus in the medial com- the flexor compartment of the leg. Approximately midway down the
partment of the thigh and gives rise to four perforating branches. calf the tibial nerve crosses behind the artery from medial to lateral.
These circle the femur posteriorly perforating, and supplying, all The artery ultimately passes behind the medial malleolus to divide into
muscles in their path. The profunda and perforating branches ulti- medial and lateral plantar arteries under the flexor retinaculum. The
mately anastomose with the genicular branches of the popliteal latter branches gain access to the sole deep to abductor hallucis.
artery. Posterior to the medial malleolus the structures which can be
identifiedafrom front to backaare: tibialis posterior, flexor digitorum
The trochanteric anastomosis longus, posterior tibial artery and venae comitantes, the tibial nerve and
This arterial anastomosis is formed by branches from the medial and flexor hallucis longus.
lateral circumflex femoral,the superior gluteal and, usually, the in- • Branches:
ferior gluteal arteries. It lies close to the trochanteric fossa and pro- • Peroneal arteryathis artery usually arises from the posterior tibial
vides branches that ascend the femoral neck beneath the retinacular artery approximately 2.5 cm along its length. It courses between
fibres of the capsule to supply the femoral head. tibialis posterior and flexor hallucis longus and supplies the per-
oneal (lateral) compartment of the leg. It ends by dividing into a
The cruciate anastomosis perforating branch that pierces the interosseous membrane and a
This anastomosis constitutes a collateral supply. It is formed by: the lateral calcaneal branch.
transverse branches of the medial and lateral circumflex femoral arter- • Other branchesathe posterior tibial artery gives rise to nutrient
ies, the descending branch of the inferior gluteal artery and the ascend- and muscular branches throughout its course.
ing branch of the 1st perforating branch of the profunda. • Lateral plantar arteryapasses between flexor accessorius and
flexor digitorum brevis to the lateral aspect of the sole where it
The popliteal artery divides into superficial and deep branches. The deep branch runs
• Course: the femoral artery continues as the popliteal artery as it between the 3rd and 4th muscle layers of the sole to continue as the
passes through the hiatus in adductor magnus to enter the popliteal deep plantar arch which is completed by the termination of the
space. From above, it descends on the posterior surface of the femur, dorsalis pedis artery. The arch gives rise to plantar metatarsal
the capsule of the knee joint and then on the fascia overlying popliteus branches which supply the toes (Fig. 42.2).
to pass under the fibrous arch of soleus where it bifurcates into anterior • Medial plantar arteryaruns on the medial aspect of the sole and
and posterior tibial arteries. In the fossa it is the deepest structure, ren- sends branches which join with the plantar metatarsal branches of
dering it difficult to feel its pulsations. The popliteal vein crosses the the lateral plantar artery to supply the toes.
artery superficially and the tibial nerve crosses from lateral to medial
over the vein. The peroneal branch of the posterior tibial may arise Peripheral vascular disease (Fig. 42.3)
early to form the popliteal trifurcation. Atheroma causes narrowing of the peripheral arteries with a con-
• Branches: muscular, sural and five genicular arteries are given off. sequent reduction in flow. Whilst flow may be adequate for tissue
The last form a rich anastomosis around the knee. perfusion at rest, exercise causes pain due to ischaemia (intermittent
claudication). When symptoms are intolerable, pain is present at
The anterior tibial artery rest or ischaemic ulceration has occurred, arterial reconstruction is
• Course: the anterior tibial artery passes anteriorly from its origin, required. Reconstruction is performed using either the patient’s own
accompanied by its venae comitantes, over the upper border of the inter- saphenous vein or a synthetic graft (Dacron or PTFE) to bypass the
osseous membrane and then descends over the anterior surface of the occlusion. Disease which is limited in extent may be suitable for inter-
membrane giving off muscular branches to the extensor compartment ventional procedures such as percutaneous transluminal angioplasty
of the leg. The artery crosses the front of the ankle joint midway be- (PTA) or stent insertion.

The arteries of the lower limb 95