What is the main artery of the lower limb?
Femoral Artery
What is the femoral artery a continuation of?
The exernal iliac artery
When does the external iliac artery become the femoral artery?
When it crosses under the inguinal ligament and enters the femoral triangle
What artery arises in the femoral triangle?
Where does it arise from?
In what direction does it travel?
The profunda femoris artery
Arises Pasterolaterally
Travels posteriorly and distally
How many branches does the profunda femoris artery give off?
Name them
3
Perforating Branches
Lateral Femoral Circumflex Artery
Medial Femoral Circumflex Artery
How many arteries make up the Perforating Branches?
What muscle does they perforate?
What muscles does it contribute arterial supply to?
Consists of 3-4
Perforates the Adductor Magnus
Muscles of the Medial and Posterior Thigh
Describe the course of the Lateral Femoral Circumflex Artery
What muscles does it supply?
Wraps around the anterior, lateral side of the femur
Supplies muscles in the lateral side of the thigh
Describe the course of the Medial Femoral Circumflex Artery
What does it supply?
In what time of injury can it be damaged and what is a consequence of this?
Wraps around the posterior side of the femur
Supplies head and neck of the femur
Fracture of the Femoral Neck
Avascular necrosis of the femur head
What is the course of the femoral artery after it exits the femoral triangle?
What does it supply as it descends?
Travels down the anterior surface of the thigh via a tunnel known as the adductor canal
Supplies the anterior thigh muscles
Where does the adductor canal end?
Where does the femoral artery continue after this?
What is the femoral artery known as after it exits the adductor canal?
At an opening in the adductor magnus called the adductor hiatus
Enters posterior compartment of the thigh, proximal to the knee
Popliteal Artery
Where can the Femoral Pulse be felt?
Where does it cross?
What does it mean if it can be felt?
Just inferior to where the femoral artery crosses the inguinal ligament
crosses exactly midway between the pubis symphysis and anteior superior iliac spine
Means blood is reaching lower extremity
Why is the femoral artery easy to access?
Runs superficially
What procedure can be performed via the femoral artery?
Describe the procedure
Coronary Angiography
"One such procedure is coronary angiography. Here, the femoral artery is catheterised with a long, thin tube. This tube is navigated up the external iliac artery, common iliac artery, aorta, and into the coronary vessels. A radioactive dye is then ejected into the coronary vessels, and any wall thickening or blockages can be visualised via x-ray imaging"
The femoral artery can be catherised to draw blood for what?
Arterial blood gases
Where does the obturator artery arise from?
Where does it descend?
Arises from internal iliac artery in the pelvic region
Descends via the obturator canal to enter the medial thigh
2
Name the two branches of the obturaor artery
Where does each branch supply?
Anterior Branch - Supplies the pectineus, obturator externus, adductor muscles and gracilis
Posterior Branch - Supplies some of the deep gluteal muscles
What is the gluteal region largely supplied by?
Where do they arise from and how do they enter the gluteal region?
The superior and inferior gluteal arteries
Also arise from the internal iliac artery
Enter via the greater sciatic foramen
Where does the superior gluteal artery leave the foramen?
What other area does the inferior gluteal artery supply?
Above the pisiform muscle
Vasculature of the posterior thigh
What artery descends down the posterior thigh?
What does it supply?
The popliteal artery
The Knee Joint
Describe the course of the popliteal artery
At what point does the popliteal artery terminate and what does it divide into?
Descends down the posterior thigh, giving off genicular branches that supply the knee joint. It moves through the popliteal fossa, exiting sandwiched between the gastrocnemius and popliteus muscles
At the lower border of the popliteus
Divides into anterior and posterior tibial arteries
In what direction does the posterior tibial artery continue?
What does it accompany into the sole of the foot with and what structure does it travel through?
Continues inferiorly along the surface of the deep muscles
Accompanies the tibial nerve in entering the sole of the foot via the tarsal tunnel
What other artery arises from the posterior tibial artery during its descent?
Where does this artery travel and what does it supply?
Moves laterally, penetrating the lateral compartment of the leg
Supplies muscles in the lateral compartment and adjacent muscles in the posterior compartment
In what direction does the anterior tibial artery travel, and through what?
What does it become in the foot?
Passes anteriorly between the tibia and fibula through a gap in the interosseous membrane and the moves inferiorly down the leg
Dorsalis Pedis Artery
What is an aneurysm?
A dilation of an artery which is greater than 50% of the normal diameter
In a popliteal artery aneurysm, what structures can be affected and why?
Other contents of the popliteal fossa because the popliteal fascial layer (roof of the popliteal fossa) is tough and non extensible
What stucture is particularly suscetible to compression from the popliteal artery?
How would this present?
Tibeal Nerve
Leg anethesia or loss of leg motor function
How would a popliteal artery aneurysm be detected?
An obvious palpable pulsation in the popliteal fossa with abnormal arterial sounds
Arterial supply in the foot is delivered by what two arteries?
Dorsalis Pedis (a continuation of the anterior tibial artery)
Posterior Tibial Artery
Describe the course of the Dorsalis Pedis
Passes over the dorsal aspect of the tarsal bones then moves inferiorly towards the sole of the foot
Then anastamoses with the lateral plantar artery to form the deep plantar arch
What does the dorsalis pedis artery supply?
Tarsal bones and dorsal aspect of the metatarsals
Via the deep plantar arch it also contributes to the supply of the toes
Describe the course of the posterior tibial artery
Enters the sole of the foot through the tarsal tunnel and then splits into the lateral and medial plantar arteries
What does the posterior tibial artery supply?
Plantar side of the foot and contributes to the supply of the toes via the deep plantar arch
What are the three main pulse points of the lower limb?
Femoral
Popliteal
Dorsalis Pedis
Where can the femoral pulse be palpated?
As it enters the femoral triangle, midway between the anterior superior iliac spine of the pelvis, and the pubis synthesis (the mid-inguinal point)
The popliteal artery is the hardest pulse to find, but where can it be palpated and how can it be made easier to find?
Lies deep in the popliteal fossa and requires deep palpation
Slight flexion of the leg (this relaxes the fascia around the popliteal fossa)
Where can the dorsalis pedis pulse be found?
Palpating on the dorsum of the foot, just lateral to extensor hallucis longus tendon