Arteries, Veins and Lymphatics of the Thigh Flashcards
Femoral artery gives rise to 7 branches
o Superficial epigastric o Superficial circumflex iliac o Superficial external pudendal (see pelvis/gluteal region) o Deep external pudendal o Muscular branches o Profunda femoris (deep femoral) o Descending genicular
Superficial epigastric artery
- Small vessel, usually the first branch of the femoral artery
Course of superficial epigastric artery
o Originates from the femoral artery about 1 cm inferior to the inguinal ligament
o Passes through femoral sheath to proceed superiorly (anterior to inguinal ligament)
o Superficial epigastric is accompanied on the medial side by the superficial epigastric vein
Superficial epigastric artery supplies…
o Supplies skin and superficial fascia of the anterior abdominal wall below umbilicus
Termination of superficial epigastric artery
o Terminates by anastomosing with the superficial epigastric from the other side and with the inferior epigastric artery
Superficial circumflex iliac artery
- Smallest branch of the femoral artery
Course of superficial circuflex iliac artery
o Originates from the anterolateral aspect of the femoral artery, slightly below the superficial epigastric
o Traveling laterally, it parallels the inguinal ligament to reach the iliac crest
Anastomosis of superficial circumflex iliac artery
Once it reaches the iliac crest, it anastomoses with 3 arteries:
- Deep circumflex iliac artery
- Superior gluteal artery
- Lateral femoral circumflex artery
Superficial external pudendal artery course
o Originates from the medial side of the femoral artery, across from the origin of the superficial circumflex iliac artery
o Traveling medially, it crosses the spermatic cord
Superficial external pudendal artery supplies…
o Once it courses the spermatic cord, the superficial external pudendal artery supplies the perineal structures and the lower anterior abdominal wall
Anastomosis of superficial external pudendal artery
o Anastomoses with branches of internal pudendal artery
Muscular arteries that originate directly from the femoral artery
The following muscles are supplied by muscular branches which originate directly from the femoral artery
o Vastus medialis
o Sartorius
o Adductor muscles
Profunda femoris artery
AKA deep femoral artery
- Largest branch of the femoral artery
Course of profunda femoris
o Originates about 2-5 cm distal to the inguinal ligament on the lateral aspect of the femoral artery
o Travels inferiorly and spirals posterior to the femoral artery then courses along its medial side
o In the lower 1/3 of the thigh, it is located posterior to the adductor longus muscle
Termination of profunda femoris
o Terminates as a small branch that enters the adductor magnus muscle
o This terminal branch of the femoral artery is known as the 4th perforating artery
Muscular branches of profunda femoris
The following branches of the profunda femoral artery supply the musculature of the anterior and medial thigh (some branches also travel deep to enter the posterior thigh
- Lateral femoral circumflex
- Medial femoral circumflex
- Perforating (4)
- Muscular branches
Lateral femoral circumflex artery (branch of the profunda femoris)
- About 20% of the time, this vessels arises from the stem of the femoral artery
Course of lateral femoral circumflex artery
o From the lateral side of the profunda femoris, the vessel proceeds laterally under cover of the rectus femoris and sartorius muscle
3 branches of lateral femoral circumflex artery
o Ascending branch of lateral femoral circumflex artery
o Transverse branch of lateral femoral circumflex artery
o Descending branch of lateral femoral circumflex artery
Ascending branch of lateral femoral circumflex artery
o Travels superolaterally deep into the fascia lata
o On the lateral side of the upper thigh, it anastomoses with branches of the superior gluteal and deep circumflex iliac arteries
Transverse branch of lateral femoral circumflex artery
o Smallest branch of the lateral femoral circumflex artery
o Travels laterally around femur inferior to greater trochanter to reach lateral side
o Pierces the vastus lateralis
o At the posterior aspect of the thigh, it participates in the formation of the cruciate anastomosis by anastomosing with the medial femoral circumflex, inferior gluteal and first perforating artery
Descending branch of lateral femoral circumflex artery
o Courses inferiorly below rectus femoris to reach and supply the vastus lateralis
o Descending branch then continues through the vastus lateralis muscle and reaches the knee joint where it anastomoses with the superior lateral genicular branch of the popliteal artery
Medial femoral circumflex (branch of the profunda femoris)
- About 25% of the time, this vessels arises directly from the femoral artery
Course of medial femoral circumflex artery
o Arises from the medial aspect of the profunda femoris
o Then travels medially to disappear between the pectineus and psoas major muscles
o Winds around the medial aspect of the femur and supplies adductor muscles, gracilis and obturator externus
Branches of medial femoral circumflex artery
o Branches anastomose with the inferior gluteal, lateral femoral circumflex and 1st perforating artery, thus contributing to the cruciate anastomosis
o Acetabular branch of medial femoral circumflex artery
Acetabular branch of medial femoral circumflex artery
- Arises opposite the acetabular notch and enters the acetabulum with the acetabular branch of the obturator artery
- Acetabular branch supplies the fat in the acetabular fossa and a branch from it travels in the round ligament to supply the head of the femur
Perforating arteries (branches of the profunda femoris)
There are usually 3 perforating arteries that originate from the profunda femoris
o The 4th perforating is the terminal end of the profunda femoris
Course of perforating arteries
o The perforating arteries pass (perforate) through the adductor magnus to reach the posterior side of the thigh
1st perforating artery
o This branch is given off superior to the adductor brevis muscle
2nd perforating artery
o Originates anteriorly to the adductor brevis muscle
o Usually gives off the nutrient artery to the femur
3rd perforating artery
o Originates distal to the adductor brevis muscle
Anastomosis
o The perforating arteries anastomose with each other and supply the adductor magnus muscle and the posterior thigh muscle
Muscular branches (branches of the profunda femoris)
- Numerous other muscular branches arise from the profunda
- Many of these branches terminate in the adductor muscles, while others go on to supply the muscles of the posterior thigh
Descending genicular artery
- Last branch of the femoral artery before it passes through the adductor hiatus
Course of descending genicular artery
o Travels medially and divides into a saphenous branch and an articular branch
Saphenous branch of descending genicular artery
o Exist the adductor canal in company with the saphenous nerve
o Distributed to the skin of the medial thigh
Articular branch of descending genicular artery
o Ends up along the medial side of the knee
o Anastomoses with the medial superior genicular and anterior recurrent tibial arteries to supply the knee joint
Popliteal artery
- Femoral artery changes its name to the popliteal artery once it exits the adductor hiatus in order to enter the popliteal fossa
Course of popliteal artery
o Popliteal artery courses inferiorly through the floor of the popliteal fossa
o Crosses the knee joint lying in the intercondylar fossa
Termination of popliteal artery
o Terminates at the inferior border of the popliteus muscle by dividing into its two terminal branches
- Anterior tibial artery
- Posterior tibial artery
Popliteal fossa
o In the popliteal fossa, the popliteal artery lies deep to the vein
o These two vessels are enclosed in a dense connective tissue sheath
o Popliteal artery is located deep in the fossa throughout its course
- Anteriorly, it lies against the capsule of the joint
- Posteriorly, it is deep to the semimembranosus muscle, popliteal vein, tibial nerve and gastrocnemius muscle
Branches of the popliteal artery in the thigh
o Muscular
o Medial superior genicular
o Lateral superior genicular
o Sural
Muscular branches of the popliteal artery (in the thigh)
- Popliteal artery gives rise to 2-3 muscular branches from its proximal end to supply the lower ends of the adductor magnus and hamstring muscles
Genicular arteries
- There are 5 genicular arteries given off by the popliteal artery to supply the knee joint
Medial and lateral superior genicular arteries
o The two superior genicular arteries arise from the medial and lateral sides of the popliteal artery
o These arteries wind around the superior aspect of the femoral condyles and reach the anterior side of the knee to help form the collateral circulation around the knee
o Both the medial and lateral superior genicular arteries give off a superficial branch that supplies the muscles in the area and a deep branch that supplies the knee joint
Middle genicular artery
o Small vessel that originates from the popliteal artery opposite the knee joint
o Enters knee joint to supply the ligaments and synovial membrane of the interior joint
Medial and lateral inferior genicular arteries
o Originate from the popliteal artery distal to the knee joint
o Will be discussed in the leg portion below
Sural arteries
- A medial and lateral sural artery originate from the popliteal artery at the knee joint and are distributed to the gastrocnemius, soleus and plantaris muscles
Superficial vein of the thigh
Great saphenous vein
Great saphenous vein at the level of the knee joint
- Courses posteriorly – passes behind medial condyles of tibia & femur
- Enters medial distal end of thigh
Course of great saphenous vein
- Superiorly, gradually reaching anterior midline of thigh (3 cm inferior to inguinal ligament)
- Passes through saphenous hiatus
- Enters femoral sheath
- Opens into femoral vein
What structures surround the proximal end of great saphenous vein?
Inguinal lymph nodes
Cribiform fascia
- Fascia that is continuous with supreficial fascia
- Covers saphenous opening
- Borders of cribiform fascia form a sharp edge which is known as the falciform margin
Superficial epigastric and superficial external pudendal arteries
- Contents of saphenous opening
- Emerge through opening
- Supply superficial structures
- Corresponding veins – drain into great saphenous (before it enters saphenous opening)
Great saphenous recieves the following before entering canal…
- Accessory saphenous vein
- Superficial external pudendal vein
- Superifical circumflex iliac vein
- Superficial epigastric vein
Accessory saphenous vein
- Formed by superifical venis along medial and posterior aspect of thigh uniting
- Drains into great saphenous
Deep veins of the thigh
- Popliteal vein
- Femoral vein
Popliteal vein
At the level of the distal border of popliteus muscle, the anterior & posterior tibial veins join to form the popliteal vein
Course of popliteal vein
- Once popliteal vein is formed, it ascends into the popliteal vein, accompanied by the popliteal artery
- In the inferior fossa, the vein is medial to artery
- In the superior fossa, the vein is superficial to artery
Tributaries of popliteal vein
- Correspond to the branches of popliteal artery
- Recieves from small saphenous vein
Discussion on varicose veins
Discussion on Varicose Veins: superificial veins of the lower limb are involved in becoming vicose. Affected veins become dialated & tortous (producing pain & possible ulcer formation) due to overextension from accumulation of blood. Not massaged by muscle like the deeper veins. Blood usually shunted to deep veins – through small connecting veins (perforating veins). Valve arrangement only lets blood go from superficial to deep veins. When varicose, some can allow blood to pass from deep to superficial veins – through incompetent valves
Femoral vein
o Largest vein of thigh
o Superior continuation of popliteal vein (at adductor hiatus)
o Ascends into adductor canal
Course of femoral vein
- In the adductor canal, the femoral vein lies posterolateral to femoral artery
- At the proximal end, it enters the apex of the femoral triangle and ascends from the posterior side of the artery to the medial side
- Inferior to the inguinal ligament, the femoral vein occupies the intermediate compartment of the femoral sheath
- Once the femoral vein crosses the inguinal ligament, it becomes the external iliac vein
Valves in femoral vein
- Usually 4-5 valvaes in femoral vein
- One usually located inferio r to entrance of deep femoral vein
Tributaries
- One of largest tributaries = deep femoral vein (profunda femoris), which is formed by the junction of the 3 or 4 perforating veins
- Also drains into interior gluteal vein (anastomotic channel between femoral and internal iliac veins)
- 3 cm inferior to inguinal ligament – receives largest tributary, great saphenous vein
- Medial & lateral femoral circumflex veins – drain into either femoral or deep femoral vein
Popliteal nodes
- 6 or 7 located in the popliteal fossa
- Subdivided into three groups related to popliteal blood supply (popliteal vein (posterior) vs. popliteal artery (anterior))
3 groups of lymph nodes
- One node lies anterior (deep) to popliteal artery which receives lymph from inside the knee joint
- One node lies posterior (superficial) to the popliteal vein and recieves lymphatics that course with the small saphenous vein
- 4 or 5 lymph nodes lie within the fat lateral and medial to the popliteal vessels and receive lymphatic vessels coursing with the anterior tibial vessels, posterior tibial vessels and peroneal blood vessels
Efferent lymphatic vessels
Vessels which are exiting the lymph nodes
- Follow femoral vein
- Go through the femoral triangle
- Enter deep inguinal lymph nodes
- A few vessels course with the great saphenous vein and enter the lower group of superficial inguinal nodes
General info on popliteal vessels
- Major and largest group of lymph nodes
- Receives lymphatic vessels from lower anterior abdominal wall, perineum and lower limb
Two major groups of popliteal lymph nodes
- Superficial
- Deep
Location of superficial popliteal lymph nodes
Within the superficial fascia
Location of deep popliteal lymph nodes
- Lie deep to the deep fascia of the leg (fascia lata)
- Run within the femoral sheath
