129 Vascular Anatomy of the Lower Extremities

The external iliac artery becomes the common femoral popliteal artery courses through the popliteal fossa, it artery after passing under the inguinal ligament. The gives multiple branches of geniculate arteries (superior common femoral artery and vein are enveloped by the lateral and medial geniculate arteries, inferior lateral and femoral sheath. Scarpa’s triangle is defined by the adduc- medial geniculate arteries). The popliteal vein lies pos- tor longus muscle medially, the Sartorious muscle later- terolateral to the artery in the adductor hiatus, dorsal to ally, and by the inguinal ligament superiorly.The femoral the artery behind the knee, and then moves medial to the vessels and nerves are in the following orientation lateral artery inferiorly. The small saphenous vein joins the to medial: femoral nerve, femoral artery, femoral vein, popliteal vein in the popliteal fossa. and lymphatics (NAVeL). The common femoral artery Approximately 3cm below the knee, the popliteal gives off several branches that include the superficial artery bifurcates into the anterior tibial artery and the epigastric artery, the superficial circumflex artery, and tibioperoneal trunk. The anterior tibial artery exits the the superficial and deep external pudendal arteries. The deep posterior compartment through the interosseous fossa ovalis is a medial opening in the fascia lata where membrane and enters the anterior compartment medial the saphenous vein enters the femoral triangle. Approx- to the fibula. Here it is joined by the deep peroneal nerve imately 4cm below the inguinal ligament, the common and continues to travel through the anterior compart- femoral artery splits into the superficial femoral artery ment toward the dorsum of the foot. and the profunda (deep femoral artery). The profunda The dorsalis pedis artery begins as a continuation of courses medially and posteriorly to the femur, giving rise the anterior tibial artery beginning anterior to the ankle to medial and lateral femoral circumflex arteries and joint. The dorsalis pedis artery traverses the dorsum of perforating branches to supply the muscles of the flexor the foot in between the tendons of the extensor hallucis compartment and the femur. An important junction is longus and the extensor digitorum longus. The dorsalis created between the geniculate arteries of the knee and pedis has named branches, including the tarsal arteries the descending branch of the lateral femoral circumflex (medial and lateral), the arcuate artery, and the first artery.This creates a source of collateral blood flow when dorsal metatarsal artery.The metatarsal arteries (second, the superficial femoral artery is occluded. third, and fourth) arise from the arcuate artery. The dor- The superficial femoral artery continues inferiorly salis pedis artery terminates as the deep plantar artery through the adductor canal (Hunter’s canal) after the and joins the plantar arch on the sole of the foot. origin of the profunda. Hunter’s canal begins at the apex The tibioperoneal trunk travels in the deep posterior of the femoral triangle. It is bordered by the vastus medi- compartment approximately 3cm distally and then alis on the anterolateral aspect, the adductor longus divides into the posterior tibial artery and the peroneal muscle on the posterior border, and by the Sartorious artery. The posterior tibial artery travels along with muscle superiorly. Hunter’s canal contains the superficial the tibial nerve in a medial course toward the medial femoral artery, the saphenous nerve, and the nerve to the malleolus. The peroneal artery travels in a lateral vastus medialis. The saphenous nerve departs the canal direction toward the ankle medial to the fibula. It termi- through the adductor hiatus to join the saphenous vein, nates in branches to the ankle and the heel. The poste- traveling toward the medial ankle and foot. rior tibial artery passes posterior to the medial malleolus The adductor hiatus marks the end of the superficial and terminates into the medial and lateral plantar arter- femoral artery and the beginning of the popliteal artery. ies. The plantar arch is formed from a communication The popliteal artery travels inferiorly between the between the deep plantar artery and the lateral plantar femoral condyles and deep to the soleus muscle. As the artery.

297