Vessels of the lower limb PDF

Vessels of the lower limb Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt  Intended Learning Outcomes (ILOs) 1. Recognize the origin, termination and branches of the vessels supplying the lower limb ...

Vessels of the lower limb Department of human Anatomy and Embryology Faculty of Medicine Mansoura National University, Egypt  Intended Learning Outcomes (ILOs) 1. Recognize the origin, termination and branches of the vessels supplying the lower limb  Agenda 1. What are the origin, termination and branches of the vessels supplying the lower limb? Ext. iliac a. Femoral a. Popliteal a. Anterior tibial Posterior a. tibial a. Dorsalis Medial Lateral pedis a. plantar a. plantar a.  Femoral a. Popliteal a.  Vessels of the lower limb Femoral Artery Def: The main artery of the lower limb. Origin: is a direct continuation of the external iliac artery at the mid- inguinal point. Course: ❑ Its upper half lies in the femoral triangle (from its base to its apex). ❑ Its lower half lies in the subsartorial (adductor canal). ❑ Its uppermost part (upper 3-4 cm) is surrounded by the femoral sheath. Termination: ends at the opening into the adductor magnus, becomes the popliteal artery.  Vessels of the lower limb Branches of femoral artery: A. In the femoral triangle: 1. Superficial inguinal arteries (3): a. Superficial external pudendal artery b. Superficial epigastric artery c. Superficial circumflex iliac artery 2. Deep external pudendal artery 3. Muscular branches 4. Profunda femoris Artery  Vessels of the lower limb 4. Profunda femoris Artery Def: The main artery supply of the thigh. Origin: It arises from the posterolateral aspect of the femoral artery, one and half inches below the inguinal ligament. Termination: It ends by piercing adductor magnus muscle as the fourth perforating artery. Branches: a. Lateral circumflex femoral artery: divides into: ascending, transverse and descending branches. b. Medial circumflex femoral artery: divides into ascending, transverse, and acetabular branches. c. Perforating arteries: four in number.  Vessels of the lower limb B. In the adductor canal: 1. Descending genicular artery: supplies the knee joint.  Vessels of the lower limb The popliteal artery Origin: begins at the opening in the adductor magnus as the continuation of the femoral artery. Termination: ends at the lower border of the popliteus by dividing into anterior and posterior tibial arteries. Branches: 1. Muscular: to the surrounding muscles. 2. Articular (genicular) to the knee (5): a- Superior medial genicular. b- Inferior medial genicular. c- Middle genicular. d- Superior lateral genicular. e- Inferior lateral genicular.  Vessels of the lower limb Anterior tibial artery Origin: one of the two terminal branches of the popliteal artery at the lower border of the popliteus. Termination: It ends in front of the ankle joint midway between the two malleoli as the dorsalis pedis artery. Branches: 1. Muscular: to the extensor group of muscles. 2. Posterior tibial recurrent artery: Shares in the anastomosis around the knee joint. 3. Anterior tibial recurrent artery: Shares in the anastomosis around the knee joint. 4. Anterior medial malleolar artery: Shares in the anastomosis around the ankle joint. 5. Anterior lateral malleolar artery: Shares in the anastomosis around the ankle joint.  Vessels of the lower limb Dorsalis pedis artery Origin: the continuation of the anterior tibial artery on the front of the ankle joint at a point midway between the medial and lateral malleoli. Course: ❑ Runs forwards on the dorsum of the foot. ❑ At the proximal end of the first interosseous space, the artery turns towards the sole between the two heads of the first dorsal interosseous muscle. Termination: by Anastomosis with the medial end of the planter arch.  Posterior Tibial Artery Deep to Soleus One of The Two Terminal Branches of and Popliteal Artery Gastrocnemius at The Lower Border of Popliteus Medial Plantar Artery Lateral Plantar Artery Flexor Digitorum Longus Flexor Tibialis Posterior Hallucis Longus Back of Tibia Back of Ankle Joint Flexor Retinaculum  Vessels of the lower limb Posterior tibial artery Origin: one of 2 terminal branches of popliteal artery at the distal border of popliteus Termination: under the flexor retinaculum midway between medial malleolus and medial tubercle of calcaneus by dividing into medial and lateral planter arteries Branches:  1- Circumflex Fibular Posterior Tibial Artery 2- Peroneal 3- Muscular Branches Branches of Peroneal Artery: i- Nutrient to Fibula 4- Nutrient to Tibia 8- Terminal Branches 5- Communicating Medial Plantar Artery 6- Malleolar Branches Lateral Plantar Artery 7- Medial Calcaneal Branches v- Muscular Branches ii- Perforating iv- Communicating iii- Lateral Calcanean vi- Multiple Terminal Calcanean Branches  VEINS OF THE LOWER LIMB Superficial veins Deep veins Small saphenous vein 3. Femoral 1. Ant. & post. tibial Great saphenous vein veins Small Great 2. Popliteal vein saphenous saphenous 2. Popliteal 3. Femoral vein 1. Ant. & post. tibial veins  Vessels of the lower limb Femoral vein Beginning: begins at the opening in the adductor magnus as the continuation of the popliteal vein. Termination: leaves the femoral triangle by passing behind the inguinal ligament where it becomes the external iliac vein. Course: passes in the subsartorial canal and in the femoral triangle, accompanied with the femoral artery. Tributaries: 1. Muscular veins. 2. Deep external pudendal vein. 3. Profunda femoris vein. 4. Medial circumflex femoral vein. 5. Lateral circumflex femoral vein. 6. Great saphenous vein.  Vessels of the lower limb The popliteal vein Beginning: at the distal border of popliteus by union of the venae commitantes of anterior and posterior tibial arteries. Termination: It leaves the popliteal fossa by passing through the opening in the adductor magnus to become the femoral vein. Tributaries: 1. Corresponding to the branches of the popliteal artery-------- 2. Short (small) saphenous vein  Vessels of the lower limb Great (long) saphenous vein: Beginning: union of the dorsal digital vein with the medial end of the dorsal venous arch. Termination: enters the femoral vein. Short (small) saphenous vein: Beginning: union of the dorsal digital vein with the lateral end of the dorsal venous arch. Termination: enters the popliteal vein.  Quiz Where the termination of the small saphenous vein? A. Great saphenous vein. B. Poploteal vein. C. Femoral vein. D. Anterior tibial vein. E. Posterior tibial vein. Answer: B  Popliteal fossa Shape: Diamond-hollow shaped region Site: Posterior to knee Boundaries: ❑ superior medial: SGSS(sartouries- gracilis- semimembranosus / semitendinosus ❑ Superior lateral: biceps femoris ❑ Inferior medial; medial head of gastrocnemius. ❑ Inferior lateral: lateral heads of gastrocnemius and plantaries. Contents: ❑ popliteal vessels ( what is the deepest structure?) ❑ Tibial and Common fibular (peroneal) nerves ❑ Popliteal L.N Semi-membranosus Biceps femoris Semi-tendinosus Gracilis Sartorius Plantaris Med. head of Lat. head of gastrocnemius gastrocnemius Roof: is formed by: 1. Skin. 2. Superficial fascia containing short saphenous vein & posterior cutaneous nerve of the thigh. 3. Deep fascia Floor: 1. The popliteal surface of the femur. 2. The capsule of the knee joint. 3. Fascia covering the popliteus muscle Contents: 1- Popliteal vessels (artery & vein). 2- Tibial nerve. 3- Common peroneal nerve. 4- Short saphenous vein. 6- Genicular branch of posterior division of the obturator nerve. 7- Popliteal lymph node. 8- Fat and areolar tissue. 9- Sympathetic plexus. Contents Popliteal fossa Popliteal vessels Tibial nerve Short saphenous vein Common peroneal nerve