Arteries of the Lower Limb

Femoral triangle | Anatomy contents page | Veins of the lower limb

Arteries of the Lower Limb

The Femoral Artery

The Femoral Sheath (p. 405)

• This oval, funnel-shaped fascial tube encloses the proximal parts of the femoral vessels, which lie inferior to the inguinal ligament. It also surrounds the femoral canal but it does not enclose the nerve.
• The femoral sheath is a diverticulum or inferior prolongation of the fasciae lining of the abdomen (trasversalis fascia anteriorly and iliac fascia posteriorly).
• It is covered by the fascia lata.

• The femoral sheath ends about 4 cm inferior to the inguinal ligament by becoming continuous with the adventitia or external loose connective tissue covering of the femoral vessels.

• The great saphenous nerve and lymphatic vessels piece the medial wall of the femoral sheath.
• The presence of the femoral sheath allows the femoral artery and vein to glide in and out, deep to the inguinal ligament, during movements of the hip joint.
• The sheath does not project into the thigh when the thigh is fully flexed, but is drawn further into the femoral triangle when the thigh is extended.

Compartments of the Femoral Sheath (p. 405)

• This sheath is subdivided by two vertical septa into three compartments: (1) a lateral compartment for the femoral artery; (2) an intermediate compartment for the femoral vein; and (3) a medial compartment or space called the femoral canal.

The Femoral Artery in the Femoral Triangle (p. 396)

• This large vessel is the continuation of the external iliac artery.
• It provides the chief arterial supply to the lower limb.

• It enters the femoral triangle deep to the midpoint of the inguinal ligament and lateral to the femoral vein.
• The femoral artery is located posterior to the deep fascia, whereas the great saphenous vein is in the superficial fascia.
• The artery descends on the psoas major, pectineus, and adductor longus muscles in the floor of the femoral triangle.

• It bisects the femoral triangle and at its apex the femoral artery runs deep to the sartorius muscle within the adductor canal.

The Femoral Artery in the Adductor Canal (p. 407)

Click here to go to the Adductor Canal

• The femoral vessels enter the adductor canal where the sartorius muscle crosses over the adductor longus muscle, the vein lying posterior to the artery.
• The femoral artery and vein leave the adductor canal through the tendinous opening in the adductor magnus muscle, known as the adductor hiatus.

• As soon as the femoral vessels enter the popliteal fossa, they are called the popliteal vessels.

• The saphenous nerve, a cutaneous branch of the femoral nerve, accompanies the femoral artery through the adductor canal.
• It enters the adductor canal lateral to the artery, crosses it anteriorly, and lies medial to it at the distal end of the canal.
• The nerve to the vastus medialis muscle accompanies the femoral artery through the proximal part of the adductor canal and then divides into the branches that supply this muscle and the knee joint.

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The Profunda Femoris Artery (p. 396)

• This deep vessel is the largest branch of the femoral artery and is the chief artery to the thigh.

• It arises from the lateral side of the femoral artery within the femoral triangle, about 4 cm inferior to the inguinal ligament.
• It runs lateral to the femoral artery and then passes posteriorly to it and the femoral vein.
• The profunda femoris artery leaves the femoral triangle between the pectineus and adductor longus muscles.
• It descends posterior to the adductor longus and gives off perforating arteries that supply the adductor magnus and hamstring muscles.

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The Circumflex Femoral Arteries (p. 396)

• The medial and lateral circumflex femoral arteries, which are branches of the profunda femoris, supply the thigh muscles and the proximal end of the femur.

• The medial circumflex femoral artery is clinically important as it supplies most of the blood to the head and neck of the femur.
• It passes deeply between the iliopsoas and pectineus muscles to reach the posterior part of the thigh.

• The lateral circumflex femoral artery passes laterally, deep to the sartorius and rectus femoris muscles, and between the branches of the femoral nerve.
• Here, it divides into branches that supply the muscles on the lateral side of the thigh and the head of the femur.

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The Popliteal Artery (pp. 423, 426)

Click here to go to the Popliteal Fossa.

• This vessel begins as soon as the femoral artery passes through the adductor hiatus in the tendon of the adductor magnus muscle.
• The popliteal artery is a continuation of the femoral artery.

• From its origin in the adductor hiatus, it passes inferolaterally through the fat of the popliteus fossa.
• It ends by dividing into the anterior and posterior tibial arteries at the inferior border of the popliteus muscle.
• The popliteal artery is located deeply throughout its course.

• Anteriorly, from proximal to distal, it lies against the fat on the posterior surface of the femur, the fibrous capsule of the knee joint, and the popliteus fascia.
• Posteriorly, from proximal to distal, it lies deep to the semimembranosus muscle, popliteal vein, tibial nerve, and gastrocnemius muscle.

• There are numerous branches of the popliteal artery. These supply the skin on the posterior aspect of the leg and the muscles of the thigh and leg.

Genicular Branches of the Popliteal Artery (p. 426)

• There are five of these branches that supply the articular capsule and the ligaments of the knee joint.
• The genicular arteries are named as follows: lateral superior and inferior, medial superior and inferior, and middle genicular arteries.

Muscular Branches of the Popliteal Artery (p. 426)

• These vessels supply the hamstrings, gastrocnemius, soleus and plantaris muscles.
• The arteries supplying the two heads of the gastrocnemius muscles, called sural arteries, may arise from a common trunk.
• The superior muscular branches of the popliteal artery have clinically important anastomoses with the terminal part of the profunda femoris and gluteal arteries.
• A cutaneous branch of the popliteal artery, the superficial sural artery, accompanies the small saphenous vein.

The Genicular Anastomoses (p. 426)

• This is an important network of arterial vessels around the knee involving ten vessels.
• The anastomoses are around the patella and the proximal ends of the tibia and fibula.

• There is a superficial network of arterial vessels between the fascia and skin, superior and inferior to the patella, and in the fat posterior to the patella.

• A deep network of arterial vessels also lies on the articular capsule of the knee joint and on the condyles of the femur and tibia.
• In addition to supplying the capsule of the knee joint, these arteries supply the adjacent bones.

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The Anterior Tibial Artery (p. 447)

• This artery and its branches supply the structures in the anterior crural compartment.
• It is the smaller of the two terminal branches of the popliteal artery.

• It begins opposite the inferior border of the popliteus muscle and ends at the ankle joint, midway between the malleoli where it becomes the dorsalis pedis artery.
• From its origin, the anterior tibial artery passes anteriorly though the interosseous membrane.
• It then descends on the anterior surface of this membrane between the extensor hallucis longus and tibialis anterior with the deep fibular nerve.
• In the distal part of the leg, the anterior tibial artery lies on the tibia.

• In addition to supplying the muscles in the anterior crural compartment, the anterior tibial artery has several named branches.

• The anterior and posterior tibial recurrent arteries join the anastomoses around the knee.
• The medial and lateral anterior malleolar arteries ramify over the medial and lateral malleoli, contributing to the arterial network over the ankle.

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The Posterior Tibial Artery (pp. 459-60)

• This vessel is the larger terminal branch of the popliteal artery, and it also begins at the distal border of the popliteus muscle.

• The posterior tibial artery passes deep to the origin of the soleus muscle, and after giving off the fibular (peroneal) artery, its largest branch, it passes inferomedially on the posterior surface of the tibialis posterior muscle.
• During its descent, it is accompanied by the tibial nerve and two venae comitantes, deep to the transverse crural intermuscular septum.
• At the ankle, the posterior tibial artery runs posterior to the medial malleolus, from which it is separated by the tendons of the tibialis posterior and flexor digitorum longus muscles.
• Inferior to the medial malleolus, it runs between the tendons of the flexor hallucis longus and flexor digitorum longus muscles.
• Deep to the flexor retinaculum and the origin of the abductor hallucis muscle, the posterior tibial artery divides into medial and lateral plantar arteries.

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The Fibular (Peroneal) Artery (p. 459-60)

• Most of the muscular branches of the posterior tibial artery are unnamed, but its most important one is the fibular artery.
• This is the largest branch of the posterior tibial artery and it begins inferior to the distal border of the popliteus muscle and the tendinous arch of the soleus.

• It descends obliquely towards the fibula and passes along its medial side within the flexor hallucis longus muscle, or between it and the intermuscular septum and tibialis posterior muscle.
• The fibular artery gives off muscular branches to the popliteus and other muscles in the posterior and lateral compartments of the leg.
• It also supplies the nutrient artery to the fibula and a communicating branch, which joins that of the posterior tibial artery.
• The fibular artery usually pierces the interosseous membrane and passes to the dorsum of the foot, where it anastomoses with the arcuate artery.

• The circumflex fibular artery, a branch of the posterior tibial, arises from the posterior tibial at the knee and passes laterally over the neck of the fibula to the anastomoses around the knee.

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The Plantar Arteries

• The posterior tibial artery divides into the medial and lateral plantar arteries deep to the flexor retinaculum and the origin of the abductor hallucis muscle.

The Medial Plantar Artery

• It is on the medial side of the foot.

The Lateral Plantar Artery

• This passes between the first and second layer to the lateral side of the foot, and it forms the plantar arch.

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