Dr. Safaa

1. Dr. Safaa

2. Objectives • Describe Anastomoses around: Hip, Knee and ankle joints • Enumerate the most important branches, and recognize the course of : Femoral, popliteal, Anterior tibial, and posterior tibial arteries • Formation of the Dorsal and Plantar arches • Differentiate between superficial and deep venous system • Recognize the importance of the valves in the circulatory system • Be familiar with the main superficial veins in the lower limb and their clinical significance • Identify the major tributaries to the main veins of the lower limb

3. Blood supply to lower limb • Right and left Common iliac arteries arise as terminal branches of the abdominal aorta at the level of L4. • Each artery ends anterior to the Sacroiliac joint by dividing into: • External Iliac • Internal Iliac

4. Internal Iliac Artery Branches which supply the lower limb • Obturator artery Leaves the pelvis through the obturator canal it gives: • Anterior and posterior branches. • Acetabular artery to head of femur. • Superior Gluteal artery Leaves through the greater sciatic foramen superior to Piriformis • Inferior Gluteal artery Leaves through the greater sciatic foramen inferior to Piriformis

6. Femoral Artery • The femoral artery is the main arterial supply to the lower limb. • The femoral artery enters the thigh from behind the inguinal ligament, as a continuation of the external iliac artery. • It enters the femoral triangle & is within the femoral sheath. • It lies midway between the anterior superior iliac spine and the symphysis pubis. • It ends at the addutor hiatus (opening in the adductor magnusmuscle) by entering the popliteal space as the popliteal artery .

7. Relations of Femoral Artrey • Anteriorly: • In the upper part is skin and fascia. • In the lower part is sartoriusmuscle • Posteriorly: • the psoas muscle • Medially: • It is related to the femoral vein in the upper part of its course • Laterally: • The femoral nerve and its branches

8. Branches of Femoral Artery • The superficial circumflex iliac artery • The superficial epigastric artery • The superficial external pudendal artery • The deep external pudendal artery • The profundafemoris artery • Descending genicular

10. Branches of Profundafemoris • Medial femoral circumflex. • Lateral femoral circumflex. • Perforating arteries (3) • Profundafemoris continues as the 4th perforating arteries

11. Trochanteric anastomosis • Branch of superior gluteal artery. • Inferior gluteal artery. • The medial femoral circumflex artery • The lateral femoral circumflex artery

12. Cruciate anastomosis • Inferior gluteal artery. • Medial femoral circumflex artery • Lateral femoral circumflex artery • First perforating artery • Cruciate & trochanteric anastomoses provide a connection between the internal iliac and the femoral arteries.

13. Popliteal artery • Continuation of femoral artery as it passes through opening in adductor magnus muscle. • It is located in the popliteal fossa • It is the deepest of the neurovascular structures in the popliteal fossa • It ends at the level of the lower border of the popliteusmuscle. • Terminates by dividing into anterior & posterior tibial arteries

14. Relations • Anteriorly: • The popliteal surface of the femur, the knee joint, and the popliteusmuscle. • Posteriorly: • The popliteal vein and the tibial nerve, fascia, and skin.

16. Branches • Muscular • Articular(genicular): • Superior genicular (lateral & medial) • Inferior genicular (lateral & medial) • Terminal Branches: • Anterior & posterior tibial arteries

17. Anastomosis around the knee Branches of femoral artery Popliteal(muscular& articular) Anterior & posterior tibial arteries

18. Anterior Tibial Artery • Artery of the anteriorFascial Compartment of the Leg. • It arises at the level of the lower border of the popliteus muscle. • Through an opening in the interosseous membrane it passes forward into the anterior compartment of the leg . • In front of the ankle joint, the artery becomes the dorsalispedisartery.

19. Anterior Tibial Artery Branches Muscular branches to neighboring muscles. Anastomotic branches that anastomose with branches of other arteries around the knee and ankle joints.

20. DorsalisPedisArtery (Dorsal artey of the foot) • It begins in front of the ankle joint as a continuation of the anterior tibialartery . • Branches: • Lateral tarsal artery • Arcuate artery • First dorsal metatarsal artery • It terminates by joining the lateral plantar artery and completes the plantar arch.

21. DorsalisPedis Artery Cont.. • Its pulsations can easily be felt between the extensor digitorumlongus tendons and the tendon of extensor hallucislongus.