Vessels of Lower Limb Flashcards
On which aspect of the limb is the single stem artery?
Flexor aspect
Where does the single stem artery bifurcate to supply different compartments?
Joint
What is the single stem artery of the lower limb?
External iliac artery
What is the relationship between the external iliac artery and the inguinal ligament?
External iliac artery passes beneath inguinal ligament
What does the external iliac artery become after passing beneath the inguinal ligament?
Femoral artery
What are the two branches of the femoral artery?
Profunda femoris
Popliteal artery
What does the profunda femoris supply?
Posterior compartment of thigh
What does the femoral artery become after the adductor hiatus?
Popliteal artery
Which anastomosis is the popliteal artery a major contributor to?
Genicular anastomosis
What does the popliteal artery become at the inferior border of popliteus?
Anterior tibial artery
Posterior tibial artery
What does the anterior tibial artery supply?
Anterior compartment of leg
What does the posterior tibial artery supply?
Posterior compartment of leg
What does the anterior tibial artery become when it passes onto the dorsum of the foot?
Dorsalis pedis
What does the dorsalis pedis supply?
Dorsum of foot
What does the posterior tibial artery become when it passes under the flexor retinaculum?
Medial plantar artery
Lateral plantar artery
What branch is given off the posterior tibial artery one inch below its origin?
Fibular artery
In what are the femoral artery and vein?
Femoral sheath
What are the three divisions of the femoral sheath, and what are each of them for?
Lateral compartment for femoral artery
Middle compartment for femoral vein
Media compartment a dead space = femoral canal, for expansion of femoral vein if needed
What is in the femoral canal?
Nothing except a couple of lymph nodes
What does the femoral canal communicate with above the inguinal ligament?
Peritoneal cavity
What is the superior mouth of the femoral canal called?
Femoral ring
What is a femoral hernia?
Abdominal contents escape into femoral canal via femoral ring
Why is a femoral hernia more common in women?
Have wider pelvis, with wider femoral ring
What does the femoral artery supply?
Anterior compartment of thigh
Is the femoral artery a superficial or deep artery?
Superficial
Over which muscle does profunda femoris travel?
Adductor magnus
How does profunda femoris supply the posterior compartment of the thigh through adductor magnus?
Many holes in adductor magnus through which profunda femoris sends perforating branches
To what does the profunda femoris run parallel?
Femur
What can a fracture to the shaft of the femur do to profunda femoris?
Tear it
What is the hiatus in adductor magnus (adductor hiatus)?
Space caused by jump on insertion before inserting into adductor tubercle
How does the femoral artery reach the posterior aspect of the knee?
Goes through adductor hiatus
How does the popliteal artery divide the popliteal fossa?
Bisects it
What neurovascular structures is the popliteal artery related to?
Popliteal vein
Tibial nerve
What is the order of the neurovascular structures descending vertically through the popliteal fossa, from superficial to deep?
Tibial nerve
Popliteal vein
Popliteal artery
What is the structure of veins below the knee?
Have paired vena comintantes
Where does the posterior tibial artery sit within the posterior compartment of the leg?
Just underneath intermuscular septum between superficial and deep muscles of posterior compartment of leg
What are the muscles around the posterior tibial artery?
Sits on tibialis posterior
Between flexor digitorum longus and flexor hallicus longus
What does the fibular artery supply?
Lateral compartment of leg
When does the anterior tibial artery become dorsalis pedis?
Once it passes under extensor retinaculum
Which artery and accompanying vena comitantes pass behind the medial malleolus, beneath the flexor retinaculum?
Posterior tibial artery
What causescompartment syndrome?
If get blow to compartment, such that muscle starts to bleed, there’s no give in boundaries of compartment
What is compartment syndrome?
Injury producing oedema/haemorrhage in one of compartments
What is the pathophysiology of compartment syndrome?
Injury to compartment > oedema/haemorrhage > compartment pressure goes up > further compromises blood flow to area > ischaemic change > more oedema > further increases in compartment pressure
Creates vicious cycle
What are the clinical features of compartment syndrome?
Distal to site of injury, limb becomes
- Painful
- Pale
- Pulseless
- Paraesthetic
- Paralysed
Why does the limb become painful in compartment syndrome?
Ischaemia
Why does the limb become pale and pulseless in compartment syndrome?
Decreased blood flow
Why does the limb become paraesthetic and paralysed in compartment syndrome?
Nerve damage
Which of the neurovascular structures is most sensitive to injury in compartment syndrome?
Nerve - can only survive 2-4 hours
How long can the muscle survive in compartment syndrome?
6-8 hours
What do the deep veins of the lower limb accompany?
Arteries
What does the superficial system of veins in the lower limb drain?
Skin
Superficial fascia
When do the vena comitantes part of the deep venous system become single veins again?
Above knee
Which main does the lower limb drain into?
Inferior vena cava
What connects the deep and superficial veins of the lower limb?
Communicating veins
What do the communicating veins perforate to connect the deep and superficial veins?
Dense layer of fascia
Why are the communicating veins of the lower limb valved?
So blood can only go from superficial to deep veins
How is blood pushed back up to the inferior vena cava?
Calf muscle pump squeezes deep veins
What vein drains the medial side of the deep venous arch?
Great saphenous vein
What vein drains the lateral side of the deep venous arch?
Short saphenous vein
What is the course of the great saphenous vein?
Drains medial side of dorsal venous arch Anterior to medial malleolus Along medial aspect of leg Posterior > hands breadth behind patella Medial aspect of thigh Penetrates deep fascia at saphenous opening Joins femoral vein
Where is the saphenous opening?
In deep fascia 2 inches below inguinal ligament
What accompanies the great saphenous vein as far as the first metatarsophalangeal joint?
Saphenous nerve
What is the course of the short saphenous vein?
Comes off lateral part of dorsal venous arch
Goes behind lateral malleolus
Straight up back of leg
Penetrates deep fascia at popliteal fossa
Enters popliteal vein
What causes varicose veins to develop?
Incompetent valves, especially at termination of
- Great saphenous vein
- Short saphenous vein
- In perforating veins
What is the pathophysiology of varicose veins?
Calf muscle pump squeezes > incompetent valves > blood pushed into superficial venous system > dilated, tortuous superficial veins > increased capillary pressure > extrusion of blood/blood products into soft tissue
What are the clinical features of varicose veins?
Broken veins
Brown pigmentation
Venous eczema
Ulceration because of ischaemia
What do deep lymphatics follow?
Arteries
What do superficial lymphatics follow?
Veins
Where do all the lymphatics following the great saphenous vein go?
Inguinal lymph nodes in groin
Where do the lymphatics following the short saphenous vein go?
Popliteal lymph nodes
What do the lymph of the popliteal lymph nodes join?
Lymph of inguinal lymph nodes
What are the two groups of inguinal lymph nodes?
Superficial
Deep
What is the arrangement of the superficial inguinal lymph nodes?
Arranged in T
Longitudinal part runs along great saphenous vein
Horizontal part runs parallel to inguinal ligament
What else do the superficial inguinal lymph nodes drain, other than the lower limb?
Anterior abdominal wall
External genitalia
Lower half of anal canal
Where do the superficial inguinal lymph nodes drain to?
Deep inguinal lymph nodes
Where are the deep inguinal lymph nodes?
Femoral canal
What do the deep inguinal lymph nodes drain?
All deep structures of lower limb, including popliteal lymph nodes
