Lower Limb

I. ARTERIAL SUPPLY (Figure 19-1)

A. The obturator artery is a continuation of the internal iliac artery. It passes through the obturator foramen close to the femoral ring, where it may complicate surgical repair of a femoral hernia. The obturator artery has the following branches:

1. Muscular branches to the adductor muscles

2. Artery of the ligamentum teres (artery to the head of the femur). This artery is important in children because it supplies the head of the femur proximal to the epiphyseal growth plate. After the epiphyseal growth plate closes (i.e., in the adult), the role of this artery in supplying blood to the head of the femur becomes insignificant.

B. Femoral artery

1. General features. The femoral artery is a continuation of the external iliac artery. It enters the femoral triangle posterior to the inguinal ligament and midway between the anterior superior iliac spine and the symphysis pubis. At this location, the femoral pulse can be palpated, arterial blood can be obtained for blood gas measurements, and percutaneous arterial catheterization can be performed.

2. Clinical consideration. The femoral artery commonly is used for percutaneous arterial catheterization because it is superficial and easily palpated, and because hemostasis can be achieved by applying pressure over the head of the femur. The preferred entry site is below the inguinal ligament at the level of the midfemoral head, a site that is confirmed by fluoroscopy. If the femoral artery is punctured above the inguinal ligament or below the femoral head, control of hemostasis may be impossible.

3. The femoral artery gives off the profunda femoris artery.

Figure 19-1. (A) Anteroposterior arteriogram of the hip region. (B) Lateral arteriogram of the ► knee region. Anterior (C) and posterior (D) views of the arterial supply of the lower limb. It is important to be able to identify an artery on an arteriogram and to state which nerve runs with that artery. ADH- adductor hiatus within the adductor magnus muscle; AT= anterior tibial artery (runs with the deep peroneal nerve); CI = common iliac artery; DP = dorsalis pedis artery; £/ = external iliac artery; F = femoral artery (runs with the femoral nerve); G = superior genicular arteries; IG = inferior gluteal artery (runs with the inferior gluteal nerve); //= internal iliac artery; LC = lateral femoral circumflex artery; LP = lateral plantar artery; MC = medial femoral circumflex artery; MP = medial plantar artery; OB = obturator artery (runs with the obturator nerve); P = popliteal artery (runs with the sciatic nerve, where it branches into the tibial nerve and common peroneal nerve); PA = plantar arch; PE = peroneal artery; PF= profunda femoris artery; PT = posterior tibial artery (runs with the tibial nerve); SG = superior gluteal artery (runs with the superior gluteal nerve). (A and B adapted with permission from Fleckenstein P, Tranum-Jensen J: Anatomy in Diagnostic Imaging. Philadelphia, WB Saunders, 1993, p 109.)

Peroneal Nerve Vaginal

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