VASCULATURE OF THE LOWER LIMB YOU DON'T HAVE TO BETTER THAN
EVERYONE ELSE, JUST BETTER THAN THE DAY BEFORE. Dr Idara
Slide 2
Regions of lower limb/ upper margin of lower limb Gateways to
lower limb Arteries of the gluteal region Artery of the lower limb
Anastomoses btwn gluteal arteries & vessels from the femoral
artery in the thigh Veins of the lower limb Gluteal region
Slide 3
Conceptual overview : pelvic inlet The pelvis is divided into 2
regions: False pelvis (greater pelvis) is the superior region
related to the upper parts of the pelvic bones & lower lumbar
vertebrae. True pelvis (lesser pelvis) is related to the inferior
parts of the pelvic bones, sacrum, & coccyx
Slide 4
Conceptual overview: pelvic outlet The diamond-shaped pelvic
outlet is formed by both bone & liga- ments. 2 ligaments : 1.
sacrospinous & 2. sacrotuberous ligaments are important
landmarks. greater sciatic foramen Lesser sciatic foramen Obturator
foramen
Slide 5
Conceptual view: muscles of pelvic walls Obturator internus
& piriformis muscles arise in the pelvis & exit through the
sciatic foramina. Piriformis m. obturator internus m.
Slide 6
Communication between the true pelvis, & lower limb 3
apertures in the pelvic wall commu- nicate with the lower limb: The
obturator canal The greater sciatic foramen The lesser sciatic
foramen 1 2 3
Slide 7
Regions of lower limb/ upper margin of lower limb
Slide 8
Gateways to lower limb They are 4 major routes by which
structures pass from the abdomen & pelvis into & out of the
lower limb. 1. Obturator canal 2. Greater sciatic foramen 3. Lesser
sciatic foramen 4. Gap between inguinal ligament & pelvic
bone.
Slide 9
Slide 10
Arteries of the gluteal region 1. Superior gluteal artery
(branch of internal iliac a.) 2. Inferior gluteal artery (branch of
internal iliac a.) 3. Obturator artery (branch of internal iliac
a.)
Slide 11
Arteries of the gluteal region 2 arteries enter the gluteal
region from the pelvic cavity through the greater sciatic foramen :
1. Inferior gluteal a. 2. Superior gluteal a. They have important
collateral anastomoses with branches of the femoral artery. 2
1
Slide 12
Muscles supplied Superior gluteal a. Superior gluteal a.
Gluteus maximus, Gluteus medius and minimus and tensor fascia lata
Inferior Gluteal a. Inferior Gluteal a. Gluteus maximus, obturator
internus, Quadratus femoris and part of the Hamstrings Obturator a.
Obturator a. branch to obturator externus, pectineus, thigh
adductors, gracilis.
Slide 13
Arteries of the lower limb The major artery supplying the lower
limb is the femoral artery. The external iliac artery becomes the
femoral artery as it passes under the inguinal ligament to enter
the femoral triangle. Femoral a.
Slide 14
Slide 15
Branches of the femoral artery 1.Superficial femoral a. 2. Deep
femoral a.( profunda femoris a.) The deep femoral a. is said to
have three branches. They are: a. Medial circumflex femoral a. b.
Lateral circumflex femoral a. c. Perforating branches
Slide 16
Branches of the deep femoral a. A. The medial circumflex
femoral a. is a branch of deep femoral a. & it supplies the
head & neck of the femur. It takes part in the cruciate
anastomosis. B. The lateral circumflex femoral a. is a branch of
the deep femoral a. It is less able to supply the femoral head and
neck, it mainly supplies muscles on the lateral side of the thigh.
It has three branches.
Slide 17
The branches of the lat circumflex femoral a. are: 1. Ascending
branch 2. Descending branch 3. Transverse branch C. perforating
arteries 1. First perforating a. 2. Second perforating a. 3. Third
perforating a. 4. The fourth perforating a. is the terminal branch
of the deep artery itself.
Slide 18
Note: Most of the blood supply to the head of femur arises
mostly from the medial circumflex femoral artery. Fracture to the
neck of the femur can compromise this blood supply leading to
avascular necrosis of the neck of femur.
Slide 19
Veins(deep) of the lower limb superficial Veins draining the
lower limb form superficial & deep groups. The major deep vein
draining the lower limb is the femoral vein. It becomes the
external iliac vein when it passes under the inguinal ligament to
enter the abdomen. Femoral vein
Slide 20
The anterior tibial vein originate and receive blood from the
dorsalis pedis veins, on the back of the foot and empties into the
popliteal vein. The posterior tibial vein also empties into the
popliteal vein. The origin of the popliteal vein is defined by the
junction of the posterior tibial vein and anterior tibial vein. It
becomes the femoral vein when leaving the adductor canal.
Slide 21
Femoral vein The femoral vein begins at the adductor canal as a
continuation of the popliteal vein. It ends at the inferior margin
of the inguinal ligament, where it becomes the external iliac
vein.
Slide 22
Veins (superficial) of the lower limb The superficial veins
form 2 major channels: Greater saphenous vein. Ascends up the
medial side of the leg, knee, thigh to connect with the femoral
vein just inferior to the inguinal ligament. Small saphenous vein.
Ascends up the posterior surface of the leg, and then join the
popliteal vein posterior to the knee; proximal to the knee, the
popliteal vein becomes the femoral vein Greater saphenous v. Small
saphenous v.
Slide 23
Anterior Compartment of the Thigh Muscles: Sartorius, iliacus,
psoas, pectineus, and quadriceps femoris Blood supply: Femoral
artery Nerve supply: Femoral nerve
Slide 24
Medial compartment of thigh Blood supply: Profunda femoris
artery and obturator artery. Nerve supply: Obturator nerve Muscles
: Gracilis, adductor longus, adductor brevis, adductor magnus, and
obturator externus.
Slide 25
Posterior compartment of thigh Muscles: Biceps femoris,
semitendinosus, semimembranosus, and a small part of the adductor
magnus (hamstring muscles) Blood supply: Branches of the profunda
femoris artery Nerve supply: Sciatic Nerve
Slide 26
Blood Vessels in the Popliteal Fossa Popliteal artery:
Continuation of the femoral artery, begins when the latter passes
through the adductor hiatus. The popliteal artery is the deepest of
the neurovascular structures in the popliteal fossa and is
therefore difficult to palpate; however, a pulse can usually be
detected by deep palpation medial to the midline. The popliteal
artery passes inferolaterally through the fossa and ends at the
inferior border of the popliteus by dividing into the anterior and
posterior tibial arteries.
Slide 27
popliteal artery In the popliteal fossa, the popliteal artery
gives rise to branches, which supply adjacent muscles, and to a
series of geniculate arteries, which contribute to vascular
anastomoses around the knee. The genicular arteries are the
superior lateral, superior medial, Middle medial and middle
lateral, and inferior medial, inferior lateral genicular
arteries
Slide 28
popliteal vein The popliteal vein begins at the distal border
of the popliteus as a continuation of the posterior tibial vein.
The small saphenous vein passes from the posterior aspect of the
lateral malleolus to the popliteal fossa, where it pierces the deep
popliteal fascia and enters the popliteal vein.
Slide 29
Arteries in the posterior compartment of leg Anterior tibial
artery Dorsalis pedis artery Superficial veins of the foot The
leg
Slide 30
Arteries in the posterior compartment of leg Posterior tibial
a. supplies the posterior & lateral compart- ments of the leg
& continues into the sole of the foot. Has 2 major branches:
Circumflex fibular a. Fibular a. Posterior tibial a. Fibular
a.
Slide 31
Anterior tibial artery The artery associated with the anterior
compartment of leg is anterior tibial a. The anterior tibial a.
gives rise to Anterior medial malleolar artery & Anterior
lateral malleolar artery Ant. Tibialis a.
Slide 32
Dorsalis pedis artery Is the continuation of the anterior
tibial a. As the anterior tibial a. crosses the ankle joint it
becomes dorsalis pedis a. Branches are: Lateral tarsal Medial
tarsal Arcuate a. 1rst dorsal metatarsal a. Dorsalis pedis a.
Slide 33
Slide 34
Veins There are interconnected networks of Deep &
Superficial veins of the foot. The deep veins follow the arteries.
Superficial veins drain into a dorsal venous arch on the dorsal
surface of the foot over the metatarsals.
Slide 35
Superficial veins of the foot Great saphenous vein Great
saphenous vein originates from the medial side of the arch &
passes anterior to the medial malleolus & onto the medial side
of the leg. It drains into the femoral vein. Small saphenous v.
Small saphenous v. originates from the lateral side of the arch
& passes posterior to the lateral malleolus & onto the back
of the leg. It drains into the popliteal vein. great saphenous v.
small saphenous v.. Dorsal venous arch
POWER REVIEW1. 1.Which arteries represent the primary arterial
supply to the thigh? The superficial & deep femoral arteries
2.Which branches of the deep femoral artery supply the head &
neck of the femur & the muscles on the lateral side of the
thigh? The medial & lateral circumflex femoral arteries 3.Where
does the superficial femoral artery terminate? It becomes the
popliteal artery at the adductor hiatus (an opening in the adductor
magnus muscle).
Slide 40
POWER REVIEW2. 4.What are the 2 most important tributaries of
the femoral veins? The great saphenous vein & the deep femoral
vein 5.What is the longest vein in the body? The great saphenous
vein 6.what fascial landmark denotes the junction of the greater
saphenous vein with the femoral vein? The fossa ovalis, an
oval-shaped aperture in the fascia lata
Slide 41
POWER REVIEW3. 7. Name the 5 major tributaries to the great
saphenous vein. Superficial circumflex iliac vein; superficial
epigastric vein in the thigh External pudendal vein; lateral
femoral cutaneous vein; anterior femoral cutaneous vein 8. What is
the function of the perforating veins of the lower extremity? They
drain the superficial venous system into the deep venous system.
Incompetence/dysfuction of these perforating veins contributes to
varicose veins of the lower extremities
Slide 42
Review1. 1. Which of the following structures passes through
the saphenous opening? 2. The small saphenous vein empties into
which of the following veins? 3. All of the following statements
concerning the femoral triangle are correct EXCEPT 4. Which of the
following statements concerning the femoral artery is correct? 5.
Which of the following statements concerning the deep artery of the
thigh is correct?
Slide 43
Review 2. 6.Which of the following arteries supplies most of
the blood to the head and neck of the femur? 7.All of the following
statements concerning the adductor canal are correct EXCEPT 8.Which
of the following statements concerning the lesser sciatic foramen
is correct? 9.All of the following structures pass through the
greater sciatic foramen EXCEPT
Slide 44
Review 3. 10. All of the following statements concerning the
popliteal fossa are correct EXCEPT 11. Which of the following
arteries provides the main blood supply for the hip joint?
Slide 45
Average person has 150 teachers in lifetime and only 3 touch
that person's life. References Clinically Oriented Anatomy, Keith
L. Moore, Arthur F. Daley 6 th Edition. Images from Google images
unknown
