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JMSCR Vol||06||Issue||10||Page 49-56||October 2018 JMSCR Vol||06||Issue||10||Page 49-56||October 2018 www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 79.54 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i10.08 Original Article Study of Branching Pattern and Surgical Anatomy of Femoral Artery Authors Dr Rekha Bhasin1*, Dr Sajad2, Dr Sunanda Raina3 1MD Tutor Demonstrator, Anatomy Department, Govt. Medical College, Jammu 2Faculty Anatomy 3Prof & HOD Anatomy, Govt. Medical College, Jammu Corresponding Author Dr Rekha Bhasin MD Tutor Demonstrator, Anatomy Department, Govt. Medical College, Jammu, India Email: [email protected] Abstract The femoral artery is the continuation of external iliac artery. It begins behind the inguinal ligament midway between anterior superior iliac spine and pubic symphysis, descends along the anteromedial part of the thigh in the femoral triangle, enter and passes through the adductor canal, and becomes the popliteal artery as it passes through an opening in adductor magnus near the junction of the middle and distal thirds of the thigh. Since femoral artery has vast clinical applications in almost all fields of medicine, it is crucial to know the arterial characteristics of lower extremity before proceeding with any interventional or surgical procedure. Due to the above said reasons, We have done a cadaveric study about femoral artery, its branching pattern and variations, with its clinical application. The origin of the femoral artery coincided with the mid inguinal point in most of the cases. The origin of the profunda femoris artery is lateral to the femoral artery in most of the cases . Based on this study, we here by conclude that femoral artery has a complex variation in its origin, and its branching patterns. We hope that this study of the branching pattern and surgical anatomy of the femoral artery will be definitely useful to the cardiologists, radiologists, plastic surgeons and vascular surgeons in the future. Keywords: Femoral Artery; Branching Pattern; Surgical Anatomy. Introduction important organ in human locomotion is one such Arteries are used by the surgeons and radiologists which the above scientists come across daily in for many procedures of their specialities. their professional life. Responsibility for teaching anatomical variations Apart from the above scientists, the plastic lies with the anatomist. Action in the mode of surgeons, oncologists, vascular surgeons, severance is the problem of the surgeon. Anatomy anaesthetists, nephrologists also encounter the and surgery are forever intertwined. Femoral femoral artery in different procedures. Hence artery being the artery of the lower limb, the femoral artery being one of the most important Dr Rekha Bhasin et al JMSCR Volume 06 Issue 10 October 2018 Page 49 JMSCR Vol||06||Issue||10||Page 49-56||October 2018 main artery in the human body, the knowledge of the abdominal superficial fascia almost upto the variations in it will definitely enhance the ability umbilicus. of the above scientists. This inculcated the interest The superficial circumflex iliac artery is the to study the different aspects of femoral artery. smallest superficial branch of femoral artery and The femoral artery is the continuation of External arises near or with the superficial epigastric artery. iliac artery. It begins behind the inguinal ligament It usually emerges through the fascia lata, lateral midway behind the inguinal ligament midway to the saphenous opening, and turns laterally distal between anterior suoperior iliac spine & pubic to the inguinal ligament towards the anterior symphysis descends along the anteromedial part superior iliac spine. of the thigh in the femoral triangle, enter and The superficial external pudendal artery arises passes through the adductor canal and becomes medially from the femoral artery, close to the popliteal artery as it passes through aducctor canal preceding branches. Emerging from the cribriform near the junction of middle and distal thirds of fascia, it passes medially usually deep to the long thigh. Its first three or four centimetres are in the saphenous vein, across the spermatic cord, to femoral sheath. The part of the artery proximal to supply the lower abdominal, penile, scrotal or the origin of profunda femoris artery is often labial skin, anastomosing with branches of the clinically termed the common femoral, while that internal pudendal artery. distal to the profunda origin is termed the The deep external pudendal artery passes medially superficial femoral artery. The profunda femoris across the pectineus and anterior or posterior to artery is termed as deep femoral artery. adductor longus, covered by fascia lata, which it In the femoral triangle, anterior to the artery are pierces to supply the skin of the perineum and the skin, superficial fascia, superficial inguinal scrotum or labium majus. lymph nodes, fascia lata, femoral sheath, The profunda femoris artery is a large branch that superficial circumflex iliac vein and the femoral arises laterally from the femoral artery about 3.5 branch of the genitofemoral nerve. Near the apex cm distal to the inguinal ligament. At first lateral of the triangle, the medial femoral cutaneous to the femoral artery, it spirals posterior to this and nerve crosses the artery from the lateral to the the femoral vein to reach the medial side of the medial side. Posteriorly lie the femoral sheath and femur. the tendons of psoas, pectineus and adductor The descending genicular artery, the distal branch longus. The femoral vein is medial to the artery in of femoral artery, arises just proximal to the the proximal part of the triangle and becomes adductor opening and immediately supplies a posterior distally at the apex. In the adductor saphenous branch. One articular branch crosses canal, anterior to the artery are the skin, above the femoropatellar surface forming an arch superficial and deep fascia, sartorius and the with lateral superior genicular artery and fibrous roof of the canal. The saphenous nerve is supplying the knee joint. The saphenous branch first lateral then anterior and finally medial to the emerges distally through the roof of the adductor artery. Posterior are adductor longus and adductor canal to accompany the saphenous nerve to the magnus; The femoral vein is also posterior medial side of the knee. proximally, but becomes lateral distally. Antero Arterial variations are verifiable facts of human lateral are vastus medialis and its nerve. constitution that can be observed from time to The superficial epigastric artery arises anteriorly time. Because of anatomic variations, surgical from the femoral artery about 1 cm distal to the injuries in the living body can inadvertently and inguinal ligament. It traverses the cribriform readily be made by even the most experienced fascia to ascend anterior to the ligament and run in surgeons. The femoral artery is easily accessible to catheterisation and thereby to investigate any Dr Rekha Bhasin et al JMSCR Volume 06 Issue 10 October 2018 Page 50 JMSCR Vol||06||Issue||10||Page 49-56||October 2018 arterial system in the body. Because of the arthrotomy disturbs the patellar blood flow and extended scopes of interventional radiology, extensor mechanism, which in turn may lead on to femoral artery is widely used for arteriography, the patellar fracture. Knowledge of circumflex ultrasound, doppler imaging etc. femoral arteries is also essential when undertaking Femoral artery is used in interventional cardiology clinical procedures within the femoral region and procedures such as catheterisation, invasive in hip joint replacement. coronary angiogram, coronary balloon stenting The profunda femoris artery is frequently etc. (Fig.1). Nephrologists also use femoral artery incorporated in vascular reconstruction procedures as an access for permanent hemodialysis. in the proximal leg. The knowledge of site of Interventional radiologists and oncologists use origin of profunda femoris artery helps in femoral artery for delivering regional intra arterial avoiding iatrogenic femoral arteriovenous fistula chemotherapy. Regional intra arterial while performing femoral artery puncture. chemotherapy has demonstrated better response Since femoral artery has vast clinical applications rate than systemic chemotherapy, particularly in in almost all fields of medicine, it is crucial to case of liver metastasis. know the arterial characteristics of lower In atherosclerotic arterial disease, sometimes the extremity before proceeding with any femoral artery may get involved, in which case interventional or surgical procedure. vascular surgeons correct the damage by doing Due to the above said reasons, We have done a femoro popliteal bypass graft. cadaveric study about femoral artery, its One of the of the branches of femoral artery branching pattern and variations, with its clinical namely the superficial external pudendal artery application may have variable relationship with the arch of great saphenous vein. Misappreciation of the Material & Methodology anatomical variation may lead onto the The study materials consists of 15 adult lower recurrences after surgical treatment of varicose limb specimens (11 males and 4 females) Which veins of the lower limb. were dissected while demonstrating Cadaveric The femoral artery also serves as an important anatomy to the first year MBBS students. The landmark for femoral nerve block for dissection was carried out as follows: A horizontal anaesthetists. Plastic surgeons uses
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