Vessels of Lower Limb

Question 1

On which aspect of the limb is the single stem artery?

Answer 1

Flexor aspect

Question 2

Where does the single stem artery bifurcate to supply different compartments?

Answer 2

Joint

Question 3

What is the single stem artery of the lower limb?

Answer 3

External iliac artery

Question 4

What is the relationship between the external iliac artery and the inguinal ligament?

Answer 4

External iliac artery passes beneath inguinal ligament

Question 5

What does the external iliac artery become after passing beneath the inguinal ligament?

Answer 5

Femoral artery

Question 6

What are the two branches of the femoral artery?

Answer 6

Profunda femoris

Popliteal artery

Question 7

What does the profunda femoris supply?

Answer 7

Posterior compartment of thigh

Question 8

What does the femoral artery become after the adductor hiatus?

Answer 8

Popliteal artery

Question 9

Which anastomosis is the popliteal artery a major contributor to?

Answer 9

Genicular anastomosis

Question 10

What does the popliteal artery become at the inferior border of popliteus?

Answer 10

Anterior tibial artery

Posterior tibial artery

Question 11

What does the anterior tibial artery supply?

Answer 11

Anterior compartment of leg

Question 12

What does the posterior tibial artery supply?

Answer 12

Posterior compartment of leg

Question 13

What does the anterior tibial artery become when it passes onto the dorsum of the foot?

Answer 13

Dorsalis pedis

Question 14

What does the dorsalis pedis supply?

Answer 14

Dorsum of foot

Question 15

What does the posterior tibial artery become when it passes under the flexor retinaculum?

Answer 15

Medial plantar artery

Lateral plantar artery

Question 16

What branch is given off the posterior tibial artery one inch below its origin?

Answer 16

Fibular artery

Question 17

In what are the femoral artery and vein?

Answer 17

Femoral sheath

Question 18

What are the three divisions of the femoral sheath, and what are each of them for?

Answer 18

Lateral compartment for femoral artery
Middle compartment for femoral vein
Media compartment a dead space = femoral canal, for expansion of femoral vein if needed

Question 19

What is in the femoral canal?

Answer 19

Nothing except a couple of lymph nodes

Question 20

What does the femoral canal communicate with above the inguinal ligament?

Answer 20

Peritoneal cavity

Question 21

What is the superior mouth of the femoral canal called?

Answer 21

Femoral ring

Question 22

What is a femoral hernia?

Answer 22

Abdominal contents escape into femoral canal via femoral ring

Question 23

Why is a femoral hernia more common in women?

Answer 23

Have wider pelvis, with wider femoral ring

Question 24

What does the femoral artery supply?

Answer 24

Anterior compartment of thigh

Question 25

Is the femoral artery a superficial or deep artery?

Answer 25

Superficial

Question 26

Over which muscle does profunda femoris travel?

Answer 26

Adductor magnus

Question 27

How does profunda femoris supply the posterior compartment of the thigh through adductor magnus?

Answer 27

Many holes in adductor magnus through which profunda femoris sends perforating branches

Question 28

To what does the profunda femoris run parallel?

Answer 28

Femur

Question 29

What can a fracture to the shaft of the femur do to profunda femoris?

Answer 29

Tear it

Question 30

What is the hiatus in adductor magnus (adductor hiatus)?

Answer 30

Space caused by jump on insertion before inserting into adductor tubercle

Question 31

How does the femoral artery reach the posterior aspect of the knee?

Answer 31

Goes through adductor hiatus

Question 32

How does the popliteal artery divide the popliteal fossa?

Answer 32

Bisects it

Question 33

What neurovascular structures is the popliteal artery related to?

Answer 33

Popliteal vein | Tibial nerve

Question 34

What is the order of the neurovascular structures descending vertically through the popliteal fossa, from superficial to deep?

Answer 34

Tibial nerve Popliteal vein Popliteal artery

Question 35

What is the structure of veins below the knee?

Answer 35

Have paired vena comintantes

Question 36

Where does the posterior tibial artery sit within the posterior compartment of the leg?

Answer 36

Just underneath intermuscular septum between superficial and deep muscles of posterior compartment of leg

Question 37

What are the muscles around the posterior tibial artery?

Answer 37

Sits on tibialis posterior | Between flexor digitorum longus and flexor hallicus longus

Question 38

What does the fibular artery supply?

Answer 38

Lateral compartment of leg

Question 39

When does the anterior tibial artery become dorsalis pedis?

Answer 39

Once it passes under extensor retinaculum

Question 40

Which artery and accompanying vena comitantes pass behind the medial malleolus, beneath the flexor retinaculum?

Answer 40

Posterior tibial artery

Question 41

What causescompartment syndrome?

Answer 41

If get blow to compartment, such that muscle starts to bleed, there's no give in boundaries of compartment

Question 42

What is compartment syndrome?

Answer 42

Injury producing oedema/haemorrhage in one of compartments

Question 43

What is the pathophysiology of compartment syndrome?

Answer 43

Injury to compartment > oedema/haemorrhage > compartment pressure goes up > further compromises blood flow to area > ischaemic change > more oedema > further increases in compartment pressure Creates vicious cycle

Question 44

What are the clinical features of compartment syndrome?

Answer 44

Distal to site of injury, limb becomes - Painful - Pale - Pulseless - Paraesthetic - Paralysed

Question 45

Why does the limb become painful in compartment syndrome?

Answer 45

Ischaemia

Question 46

Why does the limb become pale and pulseless in compartment syndrome?

Answer 46

Decreased blood flow

Question 47

Why does the limb become paraesthetic and paralysed in compartment syndrome?

Answer 47

Nerve damage

Question 48

Which of the neurovascular structures is most sensitive to injury in compartment syndrome?

Answer 48

Nerve - can only survive 2-4 hours

Question 49

How long can the muscle survive in compartment syndrome?

Answer 49

6-8 hours

Question 50

What do the deep veins of the lower limb accompany?

Answer 50

Arteries

Question 51

What does the superficial system of veins in the lower limb drain?

Answer 51

Skin | Superficial fascia

Question 52

When do the vena comitantes part of the deep venous system become single veins again?

Answer 52

Above knee

Question 53

Which main does the lower limb drain into?

Answer 53

Inferior vena cava

Question 54

What connects the deep and superficial veins of the lower limb?

Answer 54

Communicating veins

Question 55

What do the communicating veins perforate to connect the deep and superficial veins?

Answer 55

Dense layer of fascia

Question 56

Why are the communicating veins of the lower limb valved?

Answer 56

So blood can only go from superficial to deep veins

Question 57

How is blood pushed back up to the inferior vena cava?

Answer 57

Calf muscle pump squeezes deep veins

Question 58

What vein drains the medial side of the deep venous arch?

Answer 58

Great saphenous vein

Question 59

What vein drains the lateral side of the deep venous arch?

Answer 59

Short saphenous vein

Question 60

What is the course of the great saphenous vein?

Answer 60

``` Drains medial side of dorsal venous arch Anterior to medial malleolus Along medial aspect of leg Posterior > hands breadth behind patella Medial aspect of thigh Penetrates deep fascia at saphenous opening Joins femoral vein ```

Question 61

Where is the saphenous opening?

Answer 61

In deep fascia 2 inches below inguinal ligament

Question 62

What accompanies the great saphenous vein as far as the first metatarsophalangeal joint?

Answer 62

Saphenous nerve

Question 63

What is the course of the short saphenous vein?

Answer 63

Comes off lateral part of dorsal venous arch Goes behind lateral malleolus Straight up back of leg Penetrates deep fascia at popliteal fossa Enters popliteal vein

Question 64

What causes varicose veins to develop?

Answer 64

Incompetent valves, especially at termination of - Great saphenous vein - Short saphenous vein - In perforating veins

Question 65

What is the pathophysiology of varicose veins?

Answer 65

Calf muscle pump squeezes > incompetent valves > blood pushed into superficial venous system > dilated, tortuous superficial veins > increased capillary pressure > extrusion of blood/blood products into soft tissue

Question 66

What are the clinical features of varicose veins?

Answer 66

Broken veins Brown pigmentation Venous eczema Ulceration because of ischaemia

Question 67

What do deep lymphatics follow?

Answer 67

Arteries

Question 68

What do superficial lymphatics follow?

Answer 68

Veins

Question 69

Where do all the lymphatics following the great saphenous vein go?

Answer 69

Inguinal lymph nodes in groin

Question 70

Where do the lymphatics following the short saphenous vein go?

Answer 70

Popliteal lymph nodes

Question 71

What do the lymph of the popliteal lymph nodes join?

Answer 71

Lymph of inguinal lymph nodes

Question 72

What are the two groups of inguinal lymph nodes?

Answer 72

Superficial | Deep

Question 73

What is the arrangement of the superficial inguinal lymph nodes?

Answer 73

Arranged in T Longitudinal part runs along great saphenous vein Horizontal part runs parallel to inguinal ligament

Question 74

What else do the superficial inguinal lymph nodes drain, other than the lower limb?

Answer 74

Anterior abdominal wall External genitalia Lower half of anal canal

Question 75

Where do the superficial inguinal lymph nodes drain to?

Answer 75

Deep inguinal lymph nodes

Question 76

Where are the deep inguinal lymph nodes?

Answer 76

Femoral canal

Question 77

What do the deep inguinal lymph nodes drain?

Answer 77

All deep structures of lower limb, including popliteal lymph nodes