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Yr 2 Movement - term 2 and 3 > Vasculature of the Lower Limb > Flashcards

Vasculature of the Lower Limb Flashcards

1
Q

What are the superior and inferior gluteal arteries branches of?

A

The internal iliac arteries.

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2
Q

What is the cruciate anastomosis?

A

4-way anastomosis between branches of the internal iliac, profunda femoris and circumflex femoral arteries.

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3
Q

Where is the cruciate anastomosis located?

A

In the hip, posterior to the proximal femur.

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4
Q

Why is the cruciate anastomosis clinically important?

A

Allows blood to bypass blockage of external iliac or proximal femoral arteries.

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5
Q

What are the main arteries of the thigh? (3)

A
  • Femoral artery
  • Profunda femoris artery
  • Obturator artery
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6
Q

Which artery supplies the anterior compartment of the thigh?

A

Femoral artery.

-continuation of external iliac

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7
Q

What is the boundary of the femoral artery?

A

Inguinal ligament.

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8
Q

Which arteries supply the posterior compartment of the thigh?

A 
Perforating arteries (4). 
-branch of profunda femoris
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9
Q

Which tendon do the perforating arteries pierce to enter the back of the thigh?

A

Adductor magnus.

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10
Q

Which artery supplies the medial compartment of the thigh?

A

Obturator artery.

-branch of internal iliac

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11
Q

How does the abdominal aorta give rise to the femoral arteries?

A

Abdominal aorta
» common iliac arteries
» internal and external iliac arteries.

Femoral artery = continuation of external iliac artery.

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12
Q

What happens to the femoral artery at the knee?

A
  • Passes from the anterior compartment to enter the popliteal fossa.
  • Becomes popliteal artery.
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13
Q

When is the popliteal artery best palpated?

A

When the knee is flexed.

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14
Q

Where is the genicular anastomosis?

A

At the front/side of the knee.

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15
Q

What is the genicular anastomosis composed of?

A

5 genicular branches of the popliteal arteries.

sup lat, sup med, middle, inf lat, inf med

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16
Q

What is the function of the genicular anastomosis?

A

Maintains blood supply to leg during knee flexion.

-popliteal artery may be obstructed

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17
Q

What are the main arteries of the leg (below knee)? (3)

A
  • Anterior tibial artery
  • Posterior tibial artery
  • Fibular artery
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18
Q

Which artery supplies the anterior compartment of the leg?

A

Anterior tibial artery.

-terminal branch of popliteal artery

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19
Q

Which artery supplies the posterior compartment of the leg?

A

Posterior tibial artery.

-terminal branch of popliteal artery

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20
Q

Which artery supplies the lateral compartment of the leg?

A

Fibular artery.

-branch of post tibial artery

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21
Q

Which arteries are terminal branch of the popliteal artery? (2)

A

Posterior and anterior tibial arteries.

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22
Q

What are the main arteries in the foot? (2)

A

-Dorsalis pedis artery
-Med & lat plantar arteries
(-Deep plantar arch)

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23
Q

Which artery supplies the dorsal aspect of the foot?

A

Dorsalis pedis artery.

-continuation of ant tibial artery

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24
Q

Which arteries supply the plantar aspect of the foot(sole)?

A

Medial and lateral planter arteries.

-bifurcation of posterior tibial artery

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25
Q

What is the (deep) plantar arch composed of?

A

Anastomosis of deep plantar branch of dorsalis pedis artery and lateral plantar artery.

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26
Q

What proportion of the population have a superficial plantar arch?

A

5%.

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27
Q

What does the posterior tibial artery bifurcate into?

A

Medial and lateral plantar arteries.

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28
Q

Which arteries are often palpated? (4)

A
  • Femoral artery
  • Popliteal artery
  • Posterior tibial artery
  • Dorsalis pedis artery
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29
Q

Where is the femoral artery palpated?

A

In the groin.

-generally superficial and easy to palpate

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30
Q

Where is the popliteal artery palpated?

A

Deep in the popliteal fossa, against the femur.

-best when knee flexed

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31
Q

Where is the posterior tibial artery palpated?

A 
Behind malleolus (ankle). 
-medial prominence of lower tibia
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32
Q

Where is the dorsalis pedis artery palpated?

A

Imaginary line proximally from 1st and 2nd toes.

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33
Q

Why is the femoral artery vulnerable to injury?

A

Superficial in the femoral triangle.

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34
Q

Why is the femoral artery clinically important?

A

Important access point; catheter inserted&raquo_space; target organ.

-minimally invasive procedures (e.g. coronary angiogram, embolisation of berry aneurysm)

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35
Q

What is peripheral vascular disease?

A

Narrowed arteries&raquo_space; reduced blood flow to limbs.

-can occur in pelvis/lower limbs

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36
Q

What are the main causes of narrowed arteries in the lower limbs?

A
  • Atherosclerosis

- Occlusion (thrombus/embolus)

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37
Q

What causes acute ischaemia? (3)

A
  • Acute occlusion (e.g. thrombus)
  • Trauma
  • Compartment syndrome
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38
Q

How does acute ischaemia present?

A

6 P’s.

  • pain
  • pallor
  • perishingly cold
  • pulseless
  • paraesthesia
  • paralysis
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39
Q

How is acute ischaemia treated?

medical emergency

A

Depending on cause;

  • Revascularisation (prevent irreversible damage)
  • Imaging (show occlusion)
  • Graft (from common femoral to popliteal)
40
Q

Where do atherosclerotic changes often occur?

A

Lower femoral artery.

41
Q

How does chronic ischaemia develop?

A

Asymptomatic
»Intermittent claudication
»Rest/night pain
»Tissue loss/ulceration/gangrene

42
Q

What is intermittent claudication?

A

Cramping pain in the leg due to blockage of femoral artery.

43
Q

Why are the symptoms of acute ischaemia less marked in someone already suffering from chronic ischaemia?

A

Collateral circulation is better developed.

44
Q

What are the superficial veins of the lower limb? (2)

A

Great and short saphenous veins.

45
Q

Where do the saphenous veins lie?

A

In subcutaneous tissue, superficial to deep fascia.

46
Q

Where do the saphenous veins drain?

A

Into deep veins.

-femoral and popliteal veins.

47
Q

Where is the great saphenous vein located?

A

Medial leg.

-anterior to medial mallelous

48
Q

What are the deep veins of the lower limb?

A
  • Ant/post TIBIAL veins and ant/post FIBULAR veins.
  • Join&raquo_space; POPLITEAL vein.
  • Becomes FEMORAL vein.
49
Q

What type of vessels are the tibial and fibular veins?

A

Venae comitantes.

-accompany the major arteries

50
Q

What is the function of perforating veins?

A

Drain blood from superficial veins to deep veins.

51
Q

What is venous return from deeps veins aided by? (2)

A
  • Muscular contraction (‘pump’)

- Deep fascia (‘compression stocking’)

52
Q

What do incompetent valves lead to?

A

Varicose veins.

53
Q

Which veins can be used for emergency IV access? (2)

A
  • Femoral vein

- Great saphenous vein

54
Q

What can the femoral vein be used for?

A
  • Temporary access (e.g. trauma, burns)
  • Venepuncture (emergency)

NB. ideally use internal jugular/subclavian veins

55
Q

What is the great saphenous vein used for?

A

Emergency IV access.

-lies immediately ant to medial mallelous

56
Q

What causes varicose veins?

A

Increased pressure in saphenous veins due to proximal obstruction (e.g. pregnancy).

57
Q

What can happen when veins become dilated (varicose veins)?

A

Blood may stagnate in skin&raquo_space; breakdown and ulceration.

58
Q

What are complication of varicose veins? (3)

A
  • Bleeding
  • Superficial thrombophlebitis
  • Venous ulcers (med ankle)
59
Q

What are the main risk factors for DVT?

A
  • Immobility
  • Surgery
  • Malignancy
  • Pregnancy
  • Sepsis
60
Q

What proportion of untreated DVT leads to mortality due to PE?

A

1-2%.

61
Q

What is the main network of nerves in the lower limb?

A

Lumbosacral plexus.

-lumbar plexus and sacral plexus

62
Q

What is the lumbar plexus formed from?

A

Anterior rami of L1-4.

63
Q

What is the sacral plexus formed from?

A

Anterior rami of L4-S5.

64
Q

What is the sacral plexus joined by?

A

Lumbosacral trunk.

-branch of L4 anterior rami that joins L5

65
Q

Which nerves does the lumbar plexus give rise to? (2)

A
  • Obturator nerve (L2-4)

- Femoral nerve (L2-4)

66
Q

Which spinal cord levels is the obturator nerve composed of?

A

L2-4.

67
Q

Which spinal cord levels is the femoral nerve composed of?

A

L2-4.

68
Q

Which nerves does the sacral plexus give rise to? (3)

A
  • Sciatic nerve (L4-S3)
  • Superior gluteal nerve (L4-S1)
  • Inferior gluteal nerve (L5-S2)
69
Q

Which spinal cord levels is the sciatic nerve composed of?

A

L4-S3.

70
Q

Which spinal cord levels are the gluteal nerves composed of?

A

Superior: L4-S1
Inferior: L5-S1

71
Q

Where are the lumbar and sacral plexuses located?

A

Deep within pelvis and abdomen.

72
Q

What does the femoral nerve supply?

A

Anterior compartment of the thigh.

73
Q

How does the femoral nerve enter the thigh?

A

Passes under the inguinal ligament.

74
Q

What is the terminal branch of the femoral nerve?

A

Saphenous nerve.

75
Q

What does the saphenous nerve supply?

A

Skin of medial leg.

-passes through adductor hiatus

76
Q

Which nerve supplies the medial compartment of the thigh?

A

Obturator nerve.

77
Q

What does the obturator nerve divide into?

A

Anterior and posterior branches.

-lie on either side of adductor brevis

78
Q

What does the sciatic nerve supply?

A
  • Posterior thigh

- All of leg and foot

79
Q

Which 2 nerves is the sciatic nerve composed of?

A
  • Tibial nerve

- Common fibular nerve

80
Q

What is the tibial nerve composed of?

A

Anterior divisions of anterior rami.

81
Q

What is the common fibular nerve composed of?

A

Posterior divisions of anterior rami.

82
Q

Where does the sciatic nerve normally bifurcate?

A

Distal thigh.

-pelvis in 12%

83
Q

What is another name for the common fibular nerve?

A

Common perineal nerve.

84
Q

How is the sciatic nerve injured?

A
  • During intramuscular injections

- Hip injuries/dislocations

85
Q

Where must intramuscular injection be performed?

A

Superolateral quadrant.

86
Q

What does the common fibular nerve bifurcate into?

A

Superficial and deep branches.

87
Q

What does the superficial branch of the common fibular nerve supply?

A

Lateral compartment of the leg.

88
Q

What does the deep branch of the common fibular nerve supply?

A

Anterior compartment of the leg.

89
Q

Where in the common fibular nerve vulnerable?

A

As it winds around the neck of the fibula.

90
Q

What does injury to the common fibular nerve lead to?

A

Paralysis of dorsiflexor muscles.

|&raquo_space;foot drop and altered gait

91
Q

Which nerve supplies the posterior compartment of the leg?

A

Tibial nerve.

92
Q

Where does the tibial nerve bifurcate?

A

Deep to the flexor retinaculum.

93
Q

What does the tibial nerve birfurcate into?

A

Medial and lateral plantar nerves.

94
Q

What does the medial plantar nerve supply?

A
  • 4 muscles

- Skin to med 3 1/2 digits

95
Q

What does the lateral plantar nerve supply?

A
  • All other plantar muscles

- Skin to lat 1 1/2 digits

Yr 2 Movement - term 2 and 3 (13 decks)

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