Vasculature of the Lower Limb ES 2024 PDF

VASCULATURE OF THE LOWER LIMB DR. ERDEM SÖZTUTAR  ARTERIES Arteries carry blood from the heart to the distal organs The main artery of the human body is aorta After leaving the heart aorta arches to the left side (Arch of aorta) Arch of aorta has 3 branches Br...

VASCULATURE OF THE LOWER LIMB DR. ERDEM SÖZTUTAR  ARTERIES Arteries carry blood from the heart to the distal organs The main artery of the human body is aorta After leaving the heart aorta arches to the left side (Arch of aorta) Arch of aorta has 3 branches Brachiocephalic trunk Left common carotid artery Left subclavian artery  ARTERIES After the arch, aorta continues as descending aorta Descending aorta has two parts Thoracic aorta Located left to the vertebral bodies Supplies thoracic wall and cavity Passes through a posterior opening of the diaphragm Abdominal aorta  ARTERIES After the arch, aorta continues as descending aorta Descending aorta has two parts Thoracic aorta Abdominal aorta Abdominal aorta divides into common iliac arteries Common iliac artery divides into; Internal iliac a. External iliac a.  ARTERIES After the arch, aorta continues as descending aorta Descending aorta has two parts Thoracic aorta Abdominal aorta Abdominal aorta divides into common iliac arteries Common iliac artery divides into Internal iliac a. External iliac a.  ARTERIES Superior gluteal artery Originates from the internal iliac artery Leaves the pelvic cavity through the suprapiriform foramen (with sup. gluteal n.)  ARTERIES Inferior gluteal artery Originates from the internal iliac artery Leaves the pelvic cavity through the infrapiriform foramen (with inf. gluteal n.)  ARTERIES Superior gluteal artery Originates from the internal iliac artery Leaves the pelvic cavity through the suprapiriform foramen (with sup. gluteal n.) Inferior gluteal artery Originates from the internal iliac artery Leaves the pelvic cavity through the infrapiriform foramen (with inf. gluteal n.)  ARTERIES Obturator artery Originates from the internal iliac artery Enters through obturator canal Bifurcates into anterior branch and posterior branch Branches of the obturator artery supply the medial side of the thigh  ARTERIES Obturator artery Originates from the internal iliac artery Enters through obturator canal Bifurcates into anterior branch and posterior branch Branches of the obturator artery supply the medial side of the thigh Artery of ligamentum teres (artery of head of femur) is inside the Ligament of head of femur (lig. teres)  ARTERIES External iliac artery passes under the inguinal ligament (formed by aponeurosis of the external abdominal oblique muscle) Then becomes femoral artery  ARTERIES External iliac artery passes under the inguinal ligament (formed by aponeurosis of the external abdominal oblique muscle) Then becomes femoral artery  ARTERIES FEMORAL SHEATH 2 septa divide the femoral sheath of the vascular lacuna into 3 compartments Lateral compartment contains femoral artery (and femoral branch of genitofemoral nerve) Intermediate compartment contains femoral vein Medial and smallest compartment (called the femoral canal) contains some lymphatic vessels  ARTERIES FEMORAL ARTERY In the femoral triangle, pulse of the femoral artery is easily felt just inferior to the inguinal ligament midway between the pubic symphysis and the anterior superior iliac spine Femoral vein is medial to the artery Femoral canal is medial to the vein Femoral nerve is lateral to the artery  ARTERIES Femoral artery In the femoral triangle, the femoral artery and vein and associated lymphatic vessels are surrounded by a sleeve of fascia called the femoral sheath  ARTERIES Femoral artery Passes vertically through the femoral triangle Continues down in the adductor canal  ARTERIES Cribriform fascia (Hesselbach’s fascia) Roof of the femoral triangle is covered by fascia lata Fascia lata near the saphenous opening is perforated by the numerous blood and lymphatic vessels and nerves  ARTERIES Femoral artery Four small branches originate from the femoral artery in the femoral triangle Superficial epigastric artery Superficial circumflex iliac artery Superficial external pudendal artery Deep external pudendal artery They supply the skin of the upper thigh, lower abdomen and perineum  ARTERIES Femoral artery Four small branches originate from the femoral artery in the femoral triangle Superficial epigastric artery Passes through the femoral sheath and fascia lata, turns upwards in front of the inguinal ligament  ARTERIES Femoral artery Four small branches originate from the femoral artery in the femoral triangle Superficial circumflex iliac artery Pierces the fascia lata, runs parallel with the inguinal ligament as far as the crest of the ilium  ARTERIES Femoral artery Four small branches originate from the femoral artery in the femoral triangle Superficial external pudendal artery Deep external pudendal artery They both pierce the fascia lata and supply the external genital organs  ARTERIES Femoral artery The largest branch of the femoral artery is the deep artery of the thigh (profunda femoris artery) Deep artery of the thigh is the major source of blood supply to the thigh  ARTERIES Femoral artery The largest branch of the femoral artery is the deep artery of the thigh (profunda femoris artery) Deep artery of the thigh is the major source of blood supply to the thigh  ARTERIES Deep artery of the thigh (profunda femoris a.) Has several branches; Lateral circumflex femoral artery Medial circumflex femoral artery Three perforating branches  ARTERIES Medial circumflex femoral artery Turns around the iliopsoas muscle Passes medially around the shaft of the femur Anastomoses with lateral circumflex femoral artery Supplies the neck of femur  ARTERIES Medial circumflex femoral artery Turns around the iliopsoas muscle Passes medially around the shaft of the femur Anastomoses with lateral circumflex femoral artery Supplies the neck of femur  ARTERIES Lateral circumflex femoral artery Has several branches; Ascending branch Connects with medial circumflex femoral artery to form a channel which circles the neck of the femur Supplies the neck and head of the femur Transverse branch Descending branch Anastomoses with superior lateral genicular artery  ARTERIES Perforating arteries Three perforating arteries branch from the deep artery of the thigh All penetrate through the adductor magnus muscle and supply the posterior compartment of the thigh Profunda femoris terminates as 4th perforating artery  ARTERIES ADDUCTOR CANAL (Subsartorial or Hunter’s canal) Adductor canal starts from the apex of the femoral triangle Ends at the adductor hiatus (opening between adductor and hamstring heads of the adductor magnus) Adductor hiatus opens into the popliteal fossa (at the posterior thigh) Femoral artery, vein and saphenous nerve are found in the adductor canal  ARTERIES ADDUCTOR CANAL (Subsartorial or Hunter’s canal) Femoral artery and vein exit through the adductor hiatus Immediately after leaving through the hiatus (and entering the popliteal fossa) they become popliteal artery and vein  ARTERIES Femoral artery Gives a branch to supply the knee joint Descending genicular a.  ARTERIES Femoral artery Gives a branch to supply the knee joint Descending genicular a.  ARTERIES Femoral artery Femoral artery passes through adductor canal At the posterior aspect of the lower thigh femoral artery passes through adductor hiatus and becomes the popliteal artery  ARTERIES Popliteal artery Descents in the popliteal fossa obliquely  ARTERIES Popliteal artery Gives several branches to supply the knee joint Superior medial genicular a. Inferior medial genicular a. Superior lateral genicular a. Inferior lateral genicular a. They create anastomoses around the knee joint  ARTERIES Popliteal artery Gives several branches to supply the knee joint Superior medial genicular a. Inferior medial genicular a. Superior lateral genicular a. Inferior lateral genicular a. They create anastomoses around the knee joint  ARTERIES Popliteal artery Two sural arteries branch from the popliteal artery to supply the calf muscles  ARTERIES Popliteal artery Two sural arteries branch from the popliteal artery to supply the calf muscles  ARTERIES Popliteal artery Popliteal vessels and tibial nerve pass under the arch of ligament of soleus muscle  ARTERIES Popliteal artery At the posterior compartment of the leg, popliteal artery divides into; Anterior tibial a. Posterior tibial a.  ARTERIES Popliteal artery At the posterior compartment of the leg, popliteal artery divides into; Anterior tibial a. Posterior tibial a.  ARTERIES Anterior tibial artery Passes forward into anterior compartment through superior aperture in the interosseous membrane Recurrent branch connects with the anastomotic network around the knee joint  ARTERIES Anterior tibial artery Joins the perforating branch of the fibular artery Gives rise to; Anterior medial malleolar artery Anterior lateral malleolar artery At the dorsal aspect of the foot it continues as the dorsalis pedis artery  ARTERIES Anterior tibial artery Joins the perforating branch of the fibular artery Gives rise to; Anterior medial malleolar artery Anterior lateral malleolar artery At the dorsal aspect of the foot it continues as the dorsalis pedis artery  ARTERIES Anterior tibial artery Passes under the extensor retinaculum After the retinaculum, at the dorsal aspect of the foot it continues as the dorsalis pedis artery  ARTERIES Dorsalis pedis artery Branches of the dorsalis pedis; Lateral and medial tarsal arteries Arcuate artery Gives rise to dorsal metatarsal arteries (3) Dorsal metatarsal arteries divide into dorsal digital aa. First dorsal metatarsal artery Terminal branch of dorsalis pedis a. is deep plantar artery  ARTERIES Dorsalis pedis artery Branches of the dorsalis pedis a; Lateral and medial tarsal arteries Arcuate artery Gives rise to dorsal metatarsal arteries (3) Dorsal metatarsal arteries divide into dorsal digital aa. First dorsal metatarsal artery Terminal branch of dorsalis pedis a. is deep plantar artery  ARTERIES Posterior tibial artery Supplies posterior and lateral compartments of the leg It has two major branches Circumflex fibular artery – Anastomoses with the arterial network of the knee Fibular artery – Supplies the lateral side of the leg Perforating branch is the terminal branch of fibular artery passes anteriorly through inferior aperture in the interosseus membrane and anastomoses with anterior tibial artery  ARTERIES Posterior tibial artery Supplies posterior and lateral compartments of the leg Fibular artery – Supplies the lateral side of the leg  ARTERIES Posterior tibial artery Passes through the tarsal tunnel, behind the medial malleolus  ARTERIES Posterior tibial artery At the sole, bifurcates into; Medial plantar a. Supplies the medial side of the foot Lateral plantar a. Curves medially to form the deep plantar arch Between metatarsals I and II, deep plantar arch joins with the deep plantar artery (terminal branch of dorsalis pedis a.) * Superficial plantar arch – rarely occurring anastomosis between medial and lateral plantar aa.  ARTERIES Posterior tibial artery At the sole, bifurcates into; Medial plantar a. Supplies the medial side of the foot Lateral plantar a. Curves medially to form the deep plantar arch Between metatarsals I and II, deep plantar arch joins with the deep plantar artery (terminal branch of dorsalis pedis a.) * Superficial plantar arch – rarely occurring anastomosis between medial and lateral plantar aa.  ARTERIES Posterior tibial artery Lateral plantar a. Digital branch to the little toe Plantar metatarsal arteries (4) Divide into digital branches Perforating arteries (3) – anastomose with the arteries on the dorsal aspect of the foot  ARTERIES Posterior tibial artery Lateral plantar a. Digital branch to the little toe Plantar metatarsal arteries (4) Divide into digital branches  VEINS Veins of the lower limb consists of superficial and deep veins Deep veins generally follow the arteries and have similar names Superficial veins are in the superficial fascia and interconnect with deep veins  VEINS Veins of the lower limb consists of superficial and deep veins Deep veins generally follow the arteries and have similar names Anterior tibial vein Posterior tibial vein Fibular vein  VEINS Veins of the lower limb consists of superficial and deep veins Deep veins generally follow the arteries and have similar names Popliteal vein Femoral vein Deep femoral vein (profunda femoris v.)  VEINS Superficial and deep veins in the foot form interconnected networks Deep veins follow the arteries Superficial veins drain into dorsal venous arch on the dorsal surface of the foot Great saphenous vein originates from the medial side of the arch Small saphenous vein starts from the lateral side of the arch  VEINS Small saphenous vein Ascends in the superficial fascia of the posterior aspect of the leg  VEINS Small saphenous vein At the roof of the popliteal fossa it penetrates deep fascia Drains into the popliteal vein  VEINS Great saphenous vein Ascends up the medial side of the leg, knee and thigh Drains into the femoral vein  VEINS Great saphenous vein Ascends up the medial side of the leg, knee and thigh Drains into the femoral vein  VEINS Great saphenous vein The fascia lata has an aperture just inferior to the inguinal ligament (saphenous opening) Great saphenous vein passes from saphenous opening to connect with the femoral vein  VEINS Femoral vein Drains all of the venous blood of the lower limb Passes under the inguinal ligament and becomes external iliac vein  VEINS External iliac vein joins the internal iliac vein to form common iliac vein  VEINS Right and left common iliac veins join together to form the inferior vena cava Inferior vena cava pierces through the diaphragm and enters thoracic cavity  VEINS Inferior vena cava drains into the right atrium of the heart Posterior view of the heart  Thank you…