Lower Limb Blood Vessels

Question 1

What is the main artery of the lower limb?

Answer 1

Femoral artery.

Question 2

What is the femoral artery a continuation of?

Answer 2

The external iliac artery. Becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle.

Question 3

What are the three main branches off the profunda femoris artery?

Answer 3

Perforating branches - 3/4 arteries that perforate the adductor magnus, contribute to the supply of the muscles in the medial and posterior thigh.
Lateral femoral circumflex artery - wraps round the anterior, lateral side of femur, supplying some of the muscles in the lateral side of the thigh.
Medial femoral circumflex artery - wraps round the posterior side of the femur, supplying the neck and head of the femur. In a fracture of the femoral neck, this artery can easily be damaged and avascular necrosis of the femur head can occur.

Question 4

What is the anatomical course of the femoral artery?

Answer 4

Exits the femoral triangle and continues down the anterior surface of the thigh via the adductor canal. In its descent, the artery supplies the anterior thigh muscles. It moves through the adductor hiatus opening at the end of the canal, proximal to the knee, and is now the popliteal artery.

Question 5

Why is the femoral artery suitable for coronary angiograms?

Answer 5

It is situated superficially and so is easy to access.

Question 6

What happens in a coronary angiogram?

Answer 6

The femoral artery is catheterised with a long, thin tube. The tube is navigated up the external iliac artery, common iliac artery, aorta, and into the coronary vessels. A radioactive dye is injected into the coronary vessels and any wall thickening or blockages can be seen with X rays.

Question 7

What can the femoral artery be used for clinically?

Answer 7

Coronary angiograms and arterial blood gasses (catheterised to draw blood).

Question 8

Where does the obturator artery arise from?

Answer 8

The internal iliac artery in the pelvic region.

Question 9

What is the anatomical course of the obturator artery?

Answer 9

It arises from the internal iliac artery, then descends via the obturator canal to enter the medial thigh where it bifurcates into two branches: anterior and posterior branch.

Question 10

What does the anterior branch of the obturator artery supply?

Answer 10

The pectineus, obturator externus, adductor muscles and gracilis.

Question 11

What does the posterior branch of the obturator artery supply?

Answer 11

Some of the deep gluteal muscles.

Question 12

Where do the gluteal arterier arise from?

Answer 12

The internal iliac artery and enter the gluteal region via the greater sciatic foramen.

Question 13

Where does the gluteal artery the greater sciatic foramen?

Answer 13

Above the piriformis muscles, inferior below the muscle.

Question 14

What is the anatomical course of the popliteal artery?

Answer 14

Descends dow the posterior thigh and gives off genicular branch to supply the knee joint. Moves through popliteal fossa and exits sandwiched between the gastrocnmius and popliteus muscles. It terminated by bifurcating at the lower border of the popliteus into anterior and posterior tibial arteries.

Question 15

What is the anatomical course of the popliteal artery?

Answer 15

It comes from the popliteal artery. Then moves inferiorly along the surface of the deep muscles, accompanied by the tibial nerve entering the sole of the foot via the tarsal tunnel. The fibular artery arises during this descent.

Question 16

What is the anatomical course of the fibular artery?

Answer 16

Comes off the posterior tibial artery in its descent down the leg. It then moves laterally and penetrates the lateral compartment of the leg and supplies those muscles and those adjacent in the posterior compartment.

Question 17

What is the anatomical course of the anterior tibial artery?

Answer 17

It comes from the popliteal artery and passes anteriorly between the tibia and fibula, through a gap in the interosseous membrane. It then moves inferiorly down the leg and runs down the entire length of the leg and into the foot to becomes the dorsalis pedis artery.

Question 18

Why is a popliteal aneurysm a problem?

Answer 18

Because the popliteal fascial layer is tough and non extensible so an aneurysm compresses other structures in the popliteal region.

Question 19

What is a common problem of popliteal aneursyms?

Answer 19

The tibial nerve can get compressed and damaged, the leg will have anesthesia or loss of motor function.

Question 20

How can a popliteal aneurysm be detected?

Answer 20

An obvious palpable pulsation in the popliteal fossa with abnormal arterial sounds.

Question 21

What are the two arteries supplying the foot?

Answer 21

Dorsalis pedis (continuation of anterior tibial artery) and posterior tibial.

Question 22

What is the anatomical course of the dorsalis pedis artery?

Answer 22

It begins as the anterior tibial artery and enters the foot. If passes over the dorsal aspect of the tarsal bones and move inferiorly to the sole of the foot. It then anastomoses with the lateral plantar artery to form the deep plantar arch - supplies the tarsal bones and dorsal aspect of the metatarsals, also contributes to supply of toes.

Question 23

What is the anatomical course of the posterior tibial artery?

Answer 23

Enters the sole of the foot through the tarsal tunnel and splits into the lateral and medial plantar arteries. These supply the plantar side of the foot and contribute to toe supply via the deep plantar arch.

Question 24

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

Answer 24

Femoral, popliteal, and dorsalis pedis.

Question 25

How can the femoral pulse be palpated?

Answer 25

As it enters the femoral triangle, midway between the anterior superior iliac spine of the pelvis, and the pubis synthesis.

Question 26

How can the popliteal artery be palpated?

Answer 26

Requires deep palpation, helped by the patient slightly flexing their leg to relax the fascia around the popliteal fossa.

Question 27

How can the dorsalis pedis pulse by found?

Answer 27

By palpating the dorsum of the foot, just lateral to extensor hallucis longus tendon.

Question 28

What are the two main groups of veins of the lower limb?

Answer 28

Deep veins - underneath the deep fascia of the lower limb, accompany the major arteries.
Superficial veins - in the subcutaneous tissue, drain into deep veins eventually.

Question 29

What is the main venous structure of the foot?

Answer 29

The dorsal venous arch, drain into superficial veins.

Question 30

What is the anterior tibial arch formed from?

Answer 30

Veins that penetrate deep into the leg.

Question 31

Where do the plantar veins arise?

Answer 31

On the plantar aspect of the foot.

Question 32

What do the medial and lateral plantar veins combine to form?

Answer 32

Posterior tibial and fibular veins.

Question 33

How does the posterior tibial vein enter the leg?

Answer 33

Posteriorly to the medial malleolus, whilst accompanying the posterior tibial artery.

Question 34

What forms the popliteal vein?

Answer 34

The anterior tibial, posterior tibial and fibular veins uniting.

Question 35

How do the popliteal veins enter the thigh?

Answer 35

Via the adductor canal.

Question 36

What is the popliteal vein known as once it enters the thigh?

Answer 36

The femoral vein, it accompanies the femoral arteries.

Question 37

What are the main venous structures in the thigh?

Answer 37

The femoral vein and deep vein of the thigh (profunda femoris vein).

Question 38

How does the femoral vein leave the thigh?

Answer 38

Be running underneath the inguinal ligament at the external iliac vein point.

Question 39

What is the gluteal region drained venously by?

Answer 39

Inferior and superior gluteal veins, then empty into internal iliac vein.

Question 40

What is deep vein thrombosis?

Answer 40

The formation of a blood clot within the deep veins of the lower limbs, causing blockage of the vessel.

Question 41

What are the symptoms of deep vein thrombosis?

Answer 41

Pain, swelling and tenderness of the affected limb.

Question 42

What is the main complication of deep vein thrombosis?

Answer 42

Pulmonary embolism, as the thrombus can be dislodged and travel into pulmonary circulation.

Question 43

What treatment can prevent deep vein thrombosis in high risk patients?

Answer 43

Prophylactic treatment.

Question 44

What are the main superficial veins of the lower limb?

Answer 44

The great saphenous vein and the small saphenous vein.

Question 45

What is the anatomical course of the great saphenous vein?

Answer 45

It is formed by the dorsal venous arch of the foot and the dorsal vein of the great toe. It then ascends up the medial side of the leg, and passes anteriorly to the medial malleolus at the ankle, and posteriorly to the medial condyle at the knee. Moves up the knee and receives tributaries from other veins. It terminates by draining into the femoral vein inferior to the inguinal ligament.

Question 46

How can the great saphenous vein be used in surgery?

Answer 46

Harvested and used as a vessel in coronary artery bypasses.

Question 47

What is the anatomical course of the small saphenous vein?

Answer 47

Formed by the dorsal venous arch of the foot, and the dorsal vein of the little toe. It moves up the posterior side of the leg, and passes posteriorly to the lateral malleolus, along the lateral border of the calcaneal tendon. It moves between the two heads of the gastrocnemius muscles and empties into the popliteal vein in the popliteal fossa.

Question 48

What is the cause of varicose veins?

Answer 48

The valves in the veins of the legs are faulty so blood flows back into the superficial veins and causes an increased intra-luminal pressure that the veins can’t withstand. So they dilate and become torurous.

Question 49

What can complications of varicose veins cause?

Answer 49

Risen venous pressure, blood to extrude into skin from incompetence of valves, brown pigmentation and ulceration of the surrounding skin.

Question 50

How can varicose veins be treated?

Answer 50

Surgical movement of the saphenous systems, reconstruction of valves, tying off the affected valves.