Vascular Anatomy of Lower Limb PDF

C o ll e g e o f M e d ic i n e – Prof. Mujahid Khan ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0 C o ll e g e o f At the end of the lecture, students should: M e List the main arteries of the lower limb d Describe their anatomy...

C o ll e g e o f M e d ic i n e – Prof. Mujahid Khan ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0 C o ll e g e o f At the end of the lecture, students should: M e List the main arteries of the lower limb d Describe their anatomy regarding: origin, course distribution ic i & branches n e List the main arterial anastomosis – List the sites to feel the peripheral arterial pulse ‫ك‬ ‫ ل‬ Describe the anatomy of the veins of the lower limb regarding: ‫ية‬ differentiation into superficial & deep, origin, course & ‫ا‬ termination ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0 C o ll e g e o f M e d ic Loading… i n e – ‫ك‬ ‫ل‬ ‫ية‬ ‫ا‬ ‫ل‬ ‫ط‬ ‫ب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It is the main arterial supply to the lower limb Origin: It is the continuation of the external iliac artery How it enters the thigh? Behind the inguinal ligament; midway between the anterior superior iliac spine and the symphysis pubis ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Anterior: Upper part: Skin & fascia Lower part: passes behind the sartorius Loading… Posterior: Psoas (separates it from the hip J), pectineus and adductor longus Medial: Femoral vein Lateral : Femoral nerve and its branches ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  At the inguinal ligament: The vein lies medial to the artery At the apex of the femoral triangle: The vein lies posterior to the artery At the opening in the adductor magnus: The vein lies lateral to the artery ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  1. Superficial epigastric 2. Superficial circumflex iliac 3. Superficial external pudendal 4. Deep external pudendal 5. Profunda femoris ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It is an important, large artery Arises from the lateral side of the femoral artery (4cm below the inguinal ligament) It Passes medially behind the femoral vessels Branches: Medial and lateral circumflex femoral arteries Three perforating arteries It ends by becoming the 4th perforating artery ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It is the continuation of femoral artery It enters the popliteal fossa through an opening in the adductor magnus muscle ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Anterior: Popliteal surface of the femur Knee joint Popliteus muscle Posterior: Popliteal vein, tibial nerve, skin and fascia ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Branches: Muscular and articular to the knee Termination: Loading… At the lower border of popliteus muscle by dividing into Anterior and posterior tibial arteries ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It is the smaller of the two terminal branches of the popliteal artery It enters the anterior compartment of the leg through an opening in the upper part of the interosseous membrane ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It descends with the deep peroneal nerve In the upper part of its course, it lies deep In the lower part, it lies superficial in front of the lower end of the tibia Branches: Muscular and anastomotic ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Begins in front of ankle joint as a continuation of the anterior tibial artery It is superficial in position Crossed by the inferior extensor retinaculum and the first tendon of extensor digitorum brevis Medially: Tendon of extensor hallucis longus Laterally: Deep peroneal nerve & extensor digitorum longus ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It terminates by passing between the two heads of the 1st dorsal interosseous muscle It joins the lateral plantar artery to complete the plantar arch ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Lateral tarsal artery Arcuate artery 1st dorsal metatarsal artery ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Descends deep to soleus & gastrocnemius Lies on the posterior surface of tibialis posterior muscle above On the posterior surface of tibia below Its lower part is covered by skin & fascia only Passes behind medial malleolus , deep to flexor retinaculum ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Terminates by dividing into: medial & lateral plantar arteries Branches: Peroneal artery: A large artery, descends behind the fibula (the artery of the lateral compartment of the leg) ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  It Gives : Nutrient arteries to tibia & fibula Muscular branches Perforating branch to lower part of front of leg Shares in the anastomosis around the ankle joint ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The smaller of the two terminal branches of the posterior tibial artery Arises beneath the flexor retinaculum Gives: Muscular, articular and cutaneous branches Ends by supplying the medial side of the big toe ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The larger of the two terminal branches of the posterior tibial artery At the base of the 5th metatarsal bone, it curves medially to form the Deep Plantar Arch Joins the dorsalis pedis artery at the proximal end of the 1st inter- metatarsal space Gives: Muscular, articular and cutaneous branches. The plantar arch gives plantar digital arteries ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Trochanteric anastomoses: Supplies the head of the femur ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Anastomoses around the knee ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Femoral pulse: Inferior to the lingual ligament and midway between the anterior superior iliac spine and symphysis pubis Popliteal pulse: Deep in the popliteal fossa medial to the midline Posterior tibial pulse: Posteroinferior to the medial malleolus in the groove between the malleolus and the heel ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Dorsalis pedis pulse: Over the tarsal bones between the tendons of extensor hallucis longus and extensor digitorum ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The veins of the lower limb are: Superficial 2. Deep ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  They are immediately under the skin in the subcutaneous tissue Dorsal venous arch (network): Drains most of the blood of the foot through digital and communicating veins It is drained on: Medial side by the great saphenous vein Lateral side by the small saphenous vein ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  The Longest superficial vein of the body Begins from the medial end of the dorsal venous arch (as the medial marginal vein) Ascends: In front of the medial malleolus accompanied by the (saphenous nerve) Posterior to the medial condyle of the femur Passes through the saphenous Opening (2.5-3.25) cm below and lateral to the pubic tubercle Terminates in femoral vein ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Originates from the lateral end of the dorsal venous arch Loading… Ascends: Behind the lateral malleolus in company with the sural nerve Along the middle of the back leg ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Termination : 1. It may join the great saphenous vein 2. Or Bifurcates: One branch joins the great saphenous and the other joins the popliteal vein ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Popliteal vein Formed by the union of venae comitantes around the anterior & posterior tibial arteries lies posterior to popliteal artery Continue as femoral vein ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Femoral vein It enters the thigh by passing through the opening in the adductor magnus It leaves the thigh in the intermediate compartment of the femoral sheath Passes behind the inguinal ligament to become the External iliac vein ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Accompany all the major arteries and their branches Usually paired They are contained within the vascular sheath of the artery, whose pulsations help to compress and move blood in the veins. ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Connect the Great Saphenous vein with the deep veins along the medial side of the calf Their valves only allow blood to flow from the superficial to the deep veins ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Dilatation and degeneration of the superficial veins that may be complicated by ulcers More common in the postero medial part of the lower limb Results from incompetence of the valves in the perforating veins, or within the great saphenous itself This allows the passage of high pressure blood from the deep to the superficial veins. ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0  Gray's Anatomy for Students, Fourth edition Snell Clinical Anatomy, Ninth edition dicine – Clinically ‫كلية الطب‬ Oriented Anatomy , Keith L. Moore- Seventh edition Netter’s Clinical Anatomy, Second edition 0 dicine – ‫كلية الطب‬ ‫قرر‬$‫ – اسم ورقم ا‬Course Name and No. 0