Circulation and Lymphatics of the Lower Limb

Question 1

What are the branches of the internal iliac artery and their routes. (SIIO)

Answer 1

• Superior gluteal artery - Passes from pelvic cavity to gluteal region via greater sciatic foramen above piriformis muscle.
• Interior gluteal artery - Enters the gluteal region via greater sciatic foramen below piriformis muscle
• Internal pudendal artery - via lesser sciatic foramen
• Obtrator Artery - Lies on lateral wall of pelvis and passes through obtrator canal

Question 2

Describe some of the features of the external iliac artery

Answer 2

External iliac artery passes under the inguinal ligament and becomes femoral artery. Pulse is felt inferior to midpoint of inguinal point. Enters the adductor canal and passes into popliteal artery

Question 3

What are the branches of the femoral artery

Answer 3

• Superior epigastric artery
• Superior circumflex iliac artery
• Extrnal pudendal arteries
• Profunda femoris artery

Question 4

What are the branches of the profunda femoris artery

Answer 4

Medial circumflex femoral artery, lateral circumflex femoral artery and 3-4 perforators (pierce muscles)

Question 5

What is the blood supply of the hip joint?

Answer 5

Trochanteric anastomosis; medial circumflex femoral artery, lateral circumflex femoral artery, superior gluteal artery and the inferior gluteal artery. (MLIS)
Cruciate anastamosis; Medial circumflex femoral artery, lateral circumflex femoral artery and obtrator artery(MLO)

Question 6

Blood supply to the femoral head may be affected by what?

Answer 6

Fracture of the femoral neck

Question 7

Blood can still reach the popliteal artery even if there is a blockage between femoral and external iliac artery by?

Answer 7

Internal iliac then to the inferior gluteal artery, a perforating branch of profunda femoris then the lateral circumflex femoral artery, then its decending branch, superior lateral genicular artery and finally to the popliteal. It can also travel via the anastomoses between obtrator artery and branches of profunda femoris

Question 8

Describe some features of the popliteal artery

Answer 8

It is found between hiatus tendineus and lower boarder of popliteus muscle. It is the deepest structure of the popliteal fossa so it is difficult to get a pulse. It gives rise to 5 branches. Ends as the posterior and anterior tibial arteries

Question 9

Describe the blood supply of the knee

Answer 9

• 5 Genicular arteries from popliteal artery ( Superior, middle and inferior medial genicular artery and the superior and inferior lateral genicular artery)
• Branches of femoral
• Branches of profunda femoris (descending branch of lateral circumflex femoral)
• Anterior tibial recurrent artery

Question 10

What is the anterior tibial artery accompanied by? What does it supply and where does it become dorsalis pedis?

Answer 10

The deep fibular (peroneal) nerve as it descends in the anterior leg. It supplies anterior compartment of muscles and becomes dorsalis pedis inferior to extensor retinaculum.

Question 11

Describe some of the features of dorsalis pedis artery

Answer 11

It has two branches; arcuate branch and the 1st dorsal metatarsal branch which gives rise to dorsal digital arteries. Dorsalis pedis pulse is felt in the first intermetatarsal space.

Question 12

Describe the features of the posterior tibial artery

Answer 12

• Accompanies tibial nerve.
• Gives off the fibular, circumflex fibular and nutrient arteries.
• Supplies muscles in posterior compartment
• Becomes madial and lateral planter arteries after running posterior to medial malleolus

Question 13

Describe features of the lateral and medial plantar arteries

Answer 13

• Supply sole of feet
• Lateral - gives off deep branch
• Medial - gives of superficial branch
• Deep arch gives rise to plantar digital arteries

Question 14

Name the two superficial veins?

Answer 14

Great saphenous vein and the small saphenous vein

Question 15

Describe features of the great saphenous vein

Answer 15

• Ascends anterior to medial malleolus, posterior to medial condyle of femur. It also pierces the fascia lata to join the femoral vein

Question 16

Describe features of the short saphenous vein

Answer 16

Ascends posterior to lateral malleolus and penetrates deep fascia in the leg in popliteal fossa, forms popliteal vein.

Question 17

Describe the deep veins of the lower limb

Answer 17

• Vena comitantes mostly have same name as artery they supply.
• Femoral vein ascends in adductor canal from the popliteal vein
• Receives drainage from profunda femoris, great saphenous and other small branches.

Question 18

What helps venous flow return to the heart against gravity

Answer 18

Arterial pulsation, muscular contraction and negative intra-thoracic pressure

Question 19

Where do the lymphatic vessels accompanying the great saphenous and small saphenous vein?

Answer 19

Great saphenous - Drain to superficial inguinal lymph nodes and then to external iliac nodes
Small saphenous - drain to popliteal lymph nodes

Question 20

Describe some features of the superficial inguinal nodes

Answer 20

Found along the inguinal ligament and saphenous vein. They receive lymph from;

• Anterior abdominal wall
• Skin of back
• Perineum
• Gluteal region
• Superficial lower limb

Question 21

Describe some of the features of deep inguinal nodes

Answer 21

• Found in femoral triangle, medial to femoral vein.
• Receives lymph from;
• Lower limb
• Superficial inguinal nodes
• External genitalia

Question 22

Describe the travel of the lymph from the inguinal nodes

Answer 22

External iliac node, common iliac nodes, lumbar lymph nodes, cisterna chyli, thoracic duct, Pirogov’s venous angle and the venous system.