Arteries of Lower Limb

Question 1

Where does the lower limb start?

Answer 1

Inferior to iliac crest and inguinal ligament

Question 2

Describe the main branches of arteries in the thigh.

Answer 2

. Abdominal aorta in abdomen splits into left and right common iliac arteries
. Common iliac arteries split into external and internal iliac arteries
. External iliac arteries descend into lower limbs and become the common femoral arteries when they cross the inguinal ligament and enter the femoral triangle
. Common femoral arteries split into deep femoral and superficial femoral
. Superficial femoral passes through adductor canal and travels into posterior compartment of the thigh above knee to become popliteal artery

Question 3

What are the branches of the internal iliac artery? What do these branches supply?

Answer 3

Superior gluteal, inferior gluteal (both supply buttocks) obturator (supplies medial thigh)

Question 4

What does the deep femoral artery supply?

Answer 4

Thigh

Question 5

What does the anterior tibial artery supply?

Answer 5

Anterior compartment of leg (extensor digitorum longus, extensor hallucis longus, tibius anterior)

Question 6

What does the posterior tibial artery supply?

Answer 6

Posterior compartment of leg

Question 7

What does the fibular artery supply?

Answer 7

Lateral compartment of leg

Question 8

What does the dorsalis pedis artery supply?

Answer 8

Dorsum of foot

Question 9

What does the plantar arch supply?

Answer 9

Sole of foot

Question 10

What is another word used to describe fibula structures?

Answer 10

Peroneal

Question 11

What does the arcuate artery supply?

Answer 11

The distal part of the foot and the toes

Question 12

Describe the main branches of arteries in the leg.

Answer 12

. Popliteal artery (continuation of superficial femoral artery) moves through popliteal fossa, then divides into anterior tibial artery and tibial-peroneal/tibial-fibular trunk
. The tibial-fibular trunk divides into the posterior tibial and fibular/peroneal arteries. Posterior tibial becomes plantar arch in the sole of the foot
. Anterior tibial artery passes anteriorly between tibia and fibula down the leg and into the foot, where it becomes the dorsalis pedis artery
. Dorsalis pedis artery becomes arcuate artery in distal part of foot and toes

Question 13

What is another name for the deep femoral artery? Where does it branch from? What are its branches?

Answer 13

. Profunda femoris artery
. Arises from posterolateral part of common femoral artery, travels posteriorly and downwards
. Branches to give perforating branches (3 or 4 arteries that supply the adductor magnus), lateral femoral circumflex artery (wraps around anterior lateral side to supply lateral muscles of thigh), medial femoral circumflex artery (wraps around posterior side of femur to supply femoral neck.

Question 14

Which artery can be damaged in a fracture of the femoral neck? What can happen as a consequence of this kind of fracture?

Answer 14

The medial femoral circumflex artery can be damaged, which can lead to avascular (bone) necrosis of the femoral head

Question 15

What do the perforating branches supply?

Answer 15

Adductor magnus

Question 16

What does the lateral femoral circumflex artery supply?

Answer 16

Lateral muscles of thigh

Question 17

What does the medial femoral circumflex artery supply?

Answer 17

Posterior muscles of thigh

Question 18

Which arteries supply the anterior, posterior, medial, and lateral parts of the thigh?

Answer 18

. Anterior thigh supplied by superficial femoral artery
. Posterior thigh supplied by medial femoral circumflex artery
. Medial thigh supplied by obturator artery
. Lateral thigh supplied by lateral femoral circumflex artery

Question 19

Where does the superficial femoral artery travel?

Answer 19

. Travels through the adductor canal, supplying the knee
. Exits adductor canal via adductor hiatus (an opening in the adductor magnus), moving into the posterior compartment of the thigh (proximal to the knee) to become the popliteal artery

Question 20

Where is the femoral artery located in the femoral triangle?

Answer 20

Located superficially, easy to access

Question 21

What is coronary angiography? What is it used for?

Answer 21

. Femoral artery catheterised with long thin tube. Tube goes up external iliac artery, common iliac artery, aorta, and into the coronary arteries
Used to see any thickening of heart walls or blockages, which can be visualised by x-ray

Question 22

Describe the path and branches of the obturator artery.

Answer 22

. Descends via obturator canal (branches from internal iliac artery) and enters medial thigh
. Bifurcates into anterior and posterior branches

Question 23

What does the anterior branch of the obturator artery supply?

Answer 23

Pectineus, obturator externus, adductor muscles (longus, brevis, and magnus), and the gracilis

Question 24

What does the posterior branch of the obturator artery supply?

Answer 24

Some of the deep gluteal muscles, but most gluteal muscles supplied by superior and inferior gluteal arteries

Question 25

How do the superior and inferior gluteal arteries enter the gluteal region?

Answer 25

Via the great sciatic foramen

Question 26

Describe the positions of the posterior tibial and fibular arteries.

Answer 26

Both arteries run posteriorly. Fibular artery runs more laterally and posterior tibial runs more medially.

Question 27

What is an aneurysm?

Answer 27

Dilation of an artery beyond 50% of its normal diameter

Question 28

What are the consequences of a popliteal aneurysm? What are the symptoms? How can it be detected?

Answer 28

. Popliteal fascia (roof of popliteal fossa) is non-distensible, so popliteal aneurysm compresses close-by structures
. Tibial nerve compressed by popliteal artery, causes weakened/no plantarflexion, tingling of foot/posterolateral leg
. Detected by obvious palpable pulsation in popliteal fossa

Question 29

What are the 4 main pulse points in the lower limb?

Answer 29

Femoral, popliteal, dorsalis pedis, posterior tibial

Question 30

Where can you feel the femoral pulse?

Answer 30

. The mid-inguinal point, which is midway between anterior superior iliac spine of pelvis, and the pubic symphysis (palpating the femoral artery as it enters the femoral triangle)

Question 31

Where can you feel the popliteal pulse? How can you feel it more easily?

Answer 31

. Deep in popliteal fossa

. Can ask patient to flex their leg in order to relax the fascia around the popliteal fossa

Question 32

Where can you feel the dorsalis pedis pulse?

Answer 32

Dorsum of foot, just lateral to the extensor halluces longus tendon

Question 33

Where can you feel the posterior tibial pulse?

Answer 33

Inferoposteriorly to the medial malleolus (as it turns into the foot to become the plantar arch)

Question 34

Which artery provides most of the blood supply to the head and neck of the femur?

Answer 34

Medial femoral circumflex artery

Question 35

What is the cruciate anastomosis? Why is it clinically relevant?

Answer 35

. Anastomosis of the inferior gluteal, lateral and medial circumflex, and perforating branches of deep femoral arteries
. If there’s blockage between external iliac and femoral arteries, blood can still reach popliteal fossa via internal iliac route

Question 36

Describe the route of blood flow when there’s a blockage in between the external iliac and femoral arteries.

Answer 36

Internal iliac, inferior gluteal, first perforator of deep femoral, lateral circumflex femoral, descending branch, superior lateral genicular, popliteal