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Lower Limb > Arteries, Veins and Lymphatics of the Leg > Flashcards

Arteries, Veins and Lymphatics of the Leg Flashcards

1
Q

Popliteal artery

A
  • Femoral artery changes its name to the popliteal artery when it exits the adductor hiatus to enter the popliteal fossa
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2
Q

Course of popliteal artery

A

o Courses inferiorly through the floor of the popliteal fossa
o Crosses the knee joint lying in the intercondylar fossa

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3
Q

Termination of the popliteal artery

A

Terminates at the inferior border of the popliteus muscle by dividing into its two terminal branches - Anterior tibial artery and posterior tibial artery

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4
Q

Popliteal artery in the popliteal fossa

A

o In the fossa, the popliteal artery lies deep to the vein
o The two vessels are enclosed in a dense connective tissue sheath
o The popliteal artery is located deep in the fossa throughout its course
o Anteriorly, it lies against the capsule of the joint
o Posteriorly, it is deep to the semimembranosus muscle, popliteal vein, tibial nerve and gastrocnemius muscle

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5
Q

Branches of the popliteal artery

A 
o	Cutaneous branches
o	Muscular branches 
o	Medial superior genicular artery
o	Lateral superior genicular artery
o	Medial inferior genicular artery
o	Lateral inferior genicular artery
o	Middle genicular artery
o	Posterior tibial artery 
o	Anterior tibial artery
o	Sural artery
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6
Q

Cutaneous branches of the popliteal artery

A
  • Supply the superficial structures of the posterior part of the leg (either directly or indirectly)
  • Located between heads of gastrocnemius muscle
  • Some branches follow the small saphenous vein
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7
Q

Muscular branches of popliteal artery

A
  • Gives rise to 2-3 muscular branches from its proximal end

- Supplies the lower ends of the adductor magnus and hamstring muscles

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8
Q

Genicular arteries of popliteal artery

A
  • Medial and lateral superior genicular arteries
  • Middle genicular artery
  • Medial and lateral inferior genicular arteries
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9
Q

Medial and lateral inferior genicular arteries

A

o Originate from popliteal artery distal to the knee joint

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10
Q

Medial inferior genicular artery

A
  • Larger of the two
  • Passes below the medial collateral ligament
  • Supplies the tibia and knee joint
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11
Q

Lateral inferior genicular artery

A
  • Travels laterally, superior to the head of the fibula
  • Passes deep to lateral collateral ligament and the tendon of the biceps femoris
  • Its branches contribute to genicular anastomosis on the anterior side of knee
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12
Q

Sural arteries

A
  • A medial and lateral sural artery originate from the popliteal artery at the knee joint
  • They are distributed to the gastrocnemius, soleus and plantaris muscles
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13
Q

Anastmosis around knee joint (genicular anastomosis)

A
  • The knee is the largest joint in the body, needs adequate blood supply so surrounded by vessels
  • Network of anastomotic vessels is located at the anterior side of the joint around the patella
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14
Q

Arteries included in the genicular anastomosis

A

o Descending genicular artery
o Medial and lateral superior genicular arteries
o Medial and lateral inferior genicular arteries
o Descending branch of the lateral femoral circumflex artery
o Anterior and posterior tibial recurrent arteries
o Circumflex fibular artery

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15
Q

Superficial and deep branches of the genicular anastomosis

A

o Superficial branches supply soft tissues around the joint

o Deeper branches supply the knee joint

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16
Q

Blockage of vessels in genicular anastomosis

A

o If there is an abrupt blockage, anastomotic network is not sufficient to supply the joint
o If there is a gradual onset blockage, the anastomosing branches can gradually increase in size to supply an adequate amount of blood to the knee joint

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17
Q

Anterior tibial artery

A
  • Artery of the crural compartment

- Smaller than the posterior tibial artery

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18
Q

Course of anterior tibial artery

A

o Begins at the inferior border of popliteus muscle
o Passes anteriorly between the two heads of the tibialis posterior muscle through an opening in the upper end of the interosseous membrane to enter the anterior leg
o Descends on anterior surface of interosseous membrane in an inferomedial direction
o Accompanied by a venae comitantes (vein lies on either side of artery)

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19
Q

Branches of the anterior tibial artery

A 
o	Posterior tibial recurrent 
o	Anterior tibial recurrent 
o	Circumflex fibular
o	Anterior medial malleolar
o	Anterior lateral malleolar 
o	Muscular branch
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20
Q

Termination of the anterior tibial artery

A

o Ends at ankle joint (midway between medial and lateral malleoli) where it becomes the dorsalis pedis artery

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21
Q

Posterior tibial recurrent artery (branch of anterior tibial)

A
  • Small, inconstant branch which is usually the first branch of anterior tibial artery
  • Given off before anterior tibial enters the anterior crural compartment
  • Anastomoses with the inferior genicular branches to take part in genicular anastomoses
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22
Q

Anterior tibial recurrent (branch of anterior tibial)

A
  • Originates close to entrance of anterior tibial artery into the anterior crural compartment
  • It is distributed to the anterior part of the knee and joins the genicular anastomosis
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23
Q

Circumflex fibular (branch of anterior or posterior tibial)

A
  • Small vessel which ramifies around the neck of the fibula to supply the soleus and peroneus (fibularis) longus muscle
  • Artery supplies osseous and articular structures as it courses laterally around the fibular neck within the substance of the soleus muscle
  • Variation: 40% of cases, arises from anterior tibial artery, 32% of cases, arises from posterior tibial artery
24
Q

Anterior medial malleolar artery (branch of the anterior tibial)

A
  • Branch of anterior tibial artery about 5 cm proximal to ankle joint
  • Small vessel which travels inferomedially across the proximal extensor retinaculum, deep to extensor hallucis longus and tibialis anterior
  • Ramifies around the medial malleolus
  • Anastomoses with branches of the posterior tibial and medial plantar arteries
25
Q

Anterior lateral malleolar artery (branch of the anterior tibial)

A
  • Originates from lateral side of anterior tibial artery close to the origin of medial malleolar branch
  • Passes deep to the tendons of extensor digitorum longus and peroneus tertius muscles to supply lateral side of ankle joint
26
Q

Muscular branch of anterior tibial artery

A
  • Muscular branches are given off to supply muscles of anterior and lateral leg compartments
  • Some branches travel deep to anastomose with similar branches of the posterior tibial artery
27
Q

Posterior tibial artery

A

Larger than anterior tibial artery

28
Q

Course of posterior tibial artery

A

o Begins at inferior border of popliteus and has a deep course throughout its descent
o Passes deep to the origin of the soleus muscle in an inferomedial direction
o During its descent, it can be located on the posterior surface of the tibialis posterior muscle in company with the tibial nerve and two venae comitantes
o At the ankle, posterior tibial artery runs posterior to the medial malleolus
o Artery remains separate from the medial malleolus by the tendons of the tibialis posterior and flexor digitorum longus muscles
o Inferior to the medial malleolus, the artery can be located between the tendons of flexor digitorum longus and flexor hallucis longus

29
Q

Branches of posterior tibial artery

A 
o	Muscular branches
o	Peroneal artery (fibular) 
o	Nutrient artery to tibia 
o	Posterior medial malleolar 
o	Communicating branch 
o	Medial calcaneal 
o	Medial plantar 
o	Lateral plantar 
o	Circumflex fibular
30
Q

Muscular branches of posterior tibial

A 
Direct muscular branches are distributed to the following muscles:
o	Flexor hallucis longus 
o	Peroneus longus 
o	Peroneus brevis
o	Tibialis posterior 
o	Soleus
31
Q

Peroneal artery (branch of posterior tibial)

A
  • Largest branch of posterior tibial artery, located deep on the fibular side of posterior leg
32
Q

Course of peroneal artery

A

o Originates from posterior tibial artery 2 cm distal to inferior border of popliteus muscle
o Travels inferiorly along medial side of fibula

33
Q

Branches of peroneal artery

A

o Provides a nutrient branch to the fibula
o Provides muscular branches to muscles of posterior and lateral leg compartments
o Communicating branch that joins the communicating branch of the posterior tibial
o Lateral calcaneal branches
o Posterior lateral malleolar branches

34
Q

Lateral calcaneal branches of peroneal artery

A
  • Terminal branches which are given off as the peroneal artery passes the tibiofibular articulation
  • Lateral calcaneal branches then pass lateral to the side of the heel and anastomose with other branches around the heel
35
Q

Posterior lateral malleolar branches

A

Small branches which course toward the lateral malleolus and take part in the lateral malleolar network

36
Q

Nutrient artery to tibia (branch of posterior tibial)

A
  • One of the first branches of the posterior tibial artery
  • Originates just inferior to the bifurcation of the popliteal muscle
  • Largest nutrient artery of a bone in the body
  • Enters nutrient foramen which is located immediately distal to the soleal line on the posterior proximal portion of the tibia
37
Q

Posterior medial malleolar artery (branch of posterior tibial)

A
  • Small vessel that travels toward medial malleolus

- Contributes to malleolar network

38
Q

Communicating branch (branch of posterior tibial)

A
  • Travels laterally, deep to the flexor hallucis longus

- Joins with the communicating branch of the peroneal artery

39
Q

Other branches of posterior tibial

A
  • Medial calcaneal artery
  • Medial plantar artery
  • Lateral plantar artery
  • Circumflex fibular artery (usually a branch of the anterior tibial artery, but does frequently originate from the posterior tibial artery)
40
Q

Veins of the leg

A
  • Posterior tibial vein
  • Anterior tibial vein
  • Femoral vein
  • Popliteal vein
  • Small saphenous vein
  • Great saphenous vein
41
Q

Posterior tibial vein

A

o Veins of posterior compartment of leg
o Accompany posterior tibial artery as venae comitantes
o Location: between superficial & deep muscles of posterior compartment
o Drain blood from posterior muscles
o Also receive blood from superficial veins
o More consistent tributaries: Peroneal venae comitantes, which accompany the fibular artery and drain blood primarily from lateral leg (posterior & lateral compartments)

42
Q

Anterior tibial vein

A
  • Superior continuation of venae comitantes
  • Accompany dorsalis pedis artery
  • Courses between tibialis anterior & extensor hallucis longus muscles (w/anterior tibial artery)
  • At the proximal end of the leg, inferior to popliteal fossa, the vein passes through the interosseous membrane
  • Then joins the posterior tibial veins
  • This junction forms the popliteal vein
43
Q

Femoral vein

A

Superior continuation of the popliteal vein at the ADDUCTOR HIATUS

44
Q

Popliteal vein

A
  • Tributaries correspond to branches of popliteal artery
  • Also receives the small saphenous vein
  • Formed by joining of anterior and posterior tibial veins at the distal border of the popliteus muscle
  • Ascends into popliteal fossa, accompanying the artery
  • Inferior end of fossa – lies medial to artery
  • Upper end of fossa – lies superficial to artery
  • Exits popliteal fossa through adductor hiatus
45
Q

Superficial veins of the leg

A
  • Small (lesser) saphenous

- Great saphenous

46
Q

Small saphenous vein

A

• Continuation of lateral marginal vein

47
Q

Course of small saphenous vein

A

o Begins along lateral aspect of foot
o Passes into leg from behind lateral malleolus
o Ascends along lateral border of tendocalcaneus
o Reaches middle, posterior leg and communicates with great saphenous & posterior tibial veins
o Proceeds superiorly, middle, posterior leg – enters popliteal fossa
o Empties into popliteal vein between the two heads of gastrocnemius

Note: may terminate in accessory saphenous or deep veins of posterior compartment of leg.

48
Q

Valves in small saphenous vein

A

• Possesses about 7-13 valves, one of which is near its termination, accompanied by sural nerve.

49
Q

Great saphenous vein

A
  • Continuation of medial marginal vein
  • Begins at medial aspect of foot, accompanies saphenous nerve ascending up medial side of leg
  • Joins femoral vein to become external iliac vein
50
Q

Lymphatic system of the leg

A
  • Numerous vessels and nodes
  • Closely parallel veins of the leg - the two systems of lymphatics (coincide with two systems of veins), superficial & deep
51
Q

Lymph nodes

A

Anterior tibial lymph node & popliteal lymph node - Where lymphatics of leg drain into

52
Q

Anterior tibial lymph node

A
  • Inconsistent, but when present it is located within the anterior compartment of leg near interosseous membrane (inferior to the hiatus) where anterior tibial vessels pass through interosseous membrane
  • Anterior tibial lymph node receives lymph vessels coursing with anterior tibial artery and vein
  • Efferent vessels (from anterior tibial lymph node) pass to popliteal group of lymph nodes
  • If absent, anterior lymph vessels drain into popliteal lymph node
53
Q

Lymphatic vessels

A
  • Course with blood vessels
  • Lymphatic vessels begin as blind CAP
  • Vessels that course toward nodes are afferents (arrive)
  • Vessels that leave lymph nodes are efferents (exit)
54
Q

Superficial lymphatic vessels

A
  • Course with the superficial fascia
  • Lie parallel to cutaneous veins only
  • Medial lymphatic vessels course with the great saphenous vein and drain the medial side of the foot into the lower group of superfiical inguinal nodes
  • Lateral lymphatic vessels course with the small saphenous vein and drain the lateral side of the foot into the superficial popliteal lymphnode
  • Some of the lateral lymphatic vessels will cross to the medial side with the great saphenous
55
Q

Deep lymphatic vessels

A
  • Course with both arteries and veins of the anterior tibial, posterior tibial and peroneal
56
Q

Lymphatic-vessel relationships in the deep lymphatic system

A
  • Dorsalis pedis and anterior tibial vessels drain into anterior tibial nodes
  • Medial and lateral plantar vessels drain into the popliteal nodes
  • Posterior tibial and peroneal vessels drain into the popliteal nodes

Lower Limb (24 decks)

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