Case Report Unique Variation in Origin And

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Case report

Unique variation in origin and branching pattern of profunda femoris artery: a case report

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Gross Anatomy P Mergu , VS Prasad *

Abstract descends down to end in the genic- vascular reconstructive procedures3. Introduction ular anastomosis. The course and The profunda femoris is used in vari- The anatomical knowledge of varia- branches of the femoral artery in the ous procedures such as ultrasound, tions in origin, course and branching adductor canal were normal. On the arteriography, digital subtraction an- pattern of the femoral and profunda right side, the femoral and profunda giography, magnetic resonance, Dop- femoris arteries showed a normal pler imaging and recently instead of to minimise the complications in var- pattern. femoral artery4. iousfemoris surgical artery procedures. is of great significance This paper Conclusion - discusses a unique variation in origin To the best of our knowledge, these and branching pattern of the profun- arisesThe nearlateral the circumflex root of the femoral profunda ar da femoris artery. of its kind in the literature. So this femoristery (LCFA) (often is directly a lateral from branch the fem that- Case Report knowledgevariations areis of unique great help and theto clini first- In an adult male cadaver, we observed cians and surgeons. the anterior and posterior divisions a unique variation in the left femoral oforal the artery), femoral and nerve it passesand divides between into artery representing the origin of the Introduction ascending, transverse and descend- profunda femoris artery just 1 cm below the inguinal ligament. Further, have been widely mentioned in the profunda femoris artery 2 cm Arterial variations of the lower limb froming branches. the posteromedial The medial circumflexaspect of from its origin gave rise to the su- medical science and proper knowl- thefemoral profunda, artery occasionally (MCFA) originates from the edgevarious of studies.the origin At present,and branches modern of femoral artery. It gives off transverse the femoral artery are important for and ascending branches at the up- commonperficial circumflextrunk which iliac was artery from andthe anatomists, clinicians and surgeons per margin of the adductor magnus anterolateralsuperficial epigastric aspect of artery the profunda from a and from its posterior aspect, very iliac artery continues as the femo- close to its origin, the profunda femo- ralin variousartery procedures.behind the Themidinguinal external and anastomoses with the 1. LCFA, point. In the thigh, the femoral artery inferior gluteal artery and the first- femoral and from its lateral aspect to iacperforating artery branches branch of from the DFAthe lateral ris gave rise to the medial circumflex - Normally, the deep circumflex il 6 cm from its origin, it gave rise to branches as superficial epigastric,- opposite to the origin of the inferior the deep circumflex iliac artery. Also, nalsuperficial pudendal, circumflex profunda iliac, femoris superfi and epigastricaspect of artery, the external then ascends iliac artery and shows a normal branching pattern of muscularcial external branches pudendal, in the deepfemoral exter tri- runs laterally to the anterior supe- the ascending, lateral circumflex descending artery, genicular which angle; it also bifurcates as descend- rior iliac spine behind the inguinal ing genicular and muscular branches ligament1. This paper reports a case at this point, profunda also gave rise in the adductor canal1. The femoral of a unique variation in origin and toand a transversemuscular branch branch. and Additionally, an addi- catheterisation is performed in this tional descending genicular artery location2. which branches as rectus femoris Casebranching Report pattern of the PFA. and then pierces the vastus lateralis, is also called deep femoral artery - The profunda femoris artery (PFA) daver during routine anatomical from the femoral artery (sometimes dissectionIn an adult in formalin-fixedthe left lower malelimb, cawe (DFA). Normally, it arises laterally noticed a unique variation in the * Corresponding author Email: [email protected] cm distal to the inguinal ligament left femoral artery representing the medial or rarely posterior) about 3.5 1 and gives four perforated, muscular, - 2 Department of Anatomy, MediCiti Institute of ral arteries1 origin of the PFA just 1 cm below the Medical Sciences, Hyderabad, AP, India lateral and medial circumflex femo iliacinguinal artery ligament. 2 cm away Further, from its the origin PFA Department of Anatomy, MNR Medical College . In the proximal leg, the gave rise to the superficial circumflex and Hospital, Sangareddy, Medak, AP, India PFA is frequently incorporated in Licensee OA Publishing London 2014. Creative Commons Attribution License (CC-BY)

Mergu P, Prasad VS. Competing interests: none declared. Conflict of interests: none declared. interests: none declared. Conflict of interests: Competing the final manuscript. preparation, read and approved and design, manuscript conception to All authors contributed rules of disclosure. ethical Ethics (AME) for Medical the Association All authors abide by For citation purposes: Unique variation in origin and branching pattern of profunda femoris artery: a case report. OA Anatomy 2014 Feb 01;2(1):5. Page 2 of 3

Case report

the femoral artery, the mean distance common trunk which was arising these facts, the present case is of from the midinguinal point is 4.2 cm fromand superficialthe anterolateral epigastric aspect from of the a first of its kind in the literature. With and in cases where it arises from the - database. profunda femoris, the mean distance tric artery ascended anterior to the high value to the scientific literature inguinalprofunda ligamentand the superficialand entered epigas into arises laterally from the femoral cm6. But in the present study, the arteryNormally, (sometimes the profunda medial or femoris rarely from the midinguinal point is 5.79 - aspect of the profunda femoris near the superficial fascia of the anterior inguinal ligament1. The profunda itsMCFA point originated of origin, fromthat is, the 1 cm posterior below towardsabdominal the wall anterior and superficialsuperior iliac cir femorisposterior) originated about 3.5 above cm distalthe inguinal to the spine.cumflex From iliac its artery posterior coursing aspect, laterally very ligament in 1 out of 431 cases, half does not correspond to any of the - an inch below the inguinal ligament previousthe midinguinal reports. point. This finding in 3.01% of cases, and deep to ingui- close to its origin, the PFA gave ori nal ligament in 1.6% of cases . In the - gin to the MCFA and from its lateral present case, it arose from the5 femo- The deep circumflex iliac artery mediallyaspect to from the deepits origin circumflex and passed iliac ral about 1 cm below the midinguinal femoralarises from artery the in 8.4% external of cases iliac . arIn deepartery. into The the MCFA proper was femoral descending artery point. The knowledge regarding the thetery presentin 91.6% study, of cases the deepand from circum7 the- point of origin of the profunda helps its origin and ascended below the in- in avoiding the iatrogenic femoral ar- from the posterolateral aspect of the guinaland deep ligament, circumflex then iliac passed artery laterally from profundaflex iliac arteryfemoris originated about 1 cm directly below towards the anterior superior iliac femoral artery puncture4. the midinguinal point. This is also spine behind the inguinal ligament. teriovenous fistula while performing a unique variation, which adds to the posteromedial aspect of the pro- - - funda, The occasionallyMCFA commonly from thearises femoral from ture. The knowledge of origin of the teryAlso, which 6 cm shows from a its normal origin, branching the PFA artery1 the knowledge of scientific litera patterngave rise of to the the ascending, lateral circumflex descending ar genicular and transverse branch. . When the MCFA arises from deep circumflex iliac from the PFA is - funda also gave rise to the muscular branchAdditionally, and an at additional this point, descending the pro genicular artery which branches as the rectus femoris muscle and then pierces the vastus lateralis, descends down to end in the genicular anasto- and branches of the femoral artery in themosis adductor (Figures canal 1 and were 2). normal.The course On showed a normal pattern. the right side, the femoral and PFAs Discussion Previous reports have mentioned variations in origin and branching

- itingpattern a high of the origin; femoral it andrepresents PFA. In the present case, the profunda is exhib Figure 1: Branches of the femoral and profunda femoris arteries along with origin of the superficial epigastric, iliacsuperficial arteries circumflex very close iliac,to its medialorigin, - andcircumflex the additional iliac and descending deep circumflex genic- femoral vein. CFA, common femoral artery; FV, femoral vein; FA, femoral artery;- ular artery also arises from the pro- PFA, profunda femoris artery; SEA, superficial epigastric artery; SEIA, superfi funda. To the best of our knowledge cial external iliac artery; DEIA, deep external iliac artery; MCFA, medial circum these variations are unique and the flex femoral artery; LCFA, lateral circumflex femoral artery; ADGA, additional descending genicular artery; MA, muscular artery; SEPA, superficial external Licensee OA Publishing Londonpudendal 2014. artery; Creative DEPA, deepCommons external Attribution pudendal artery; License IL, inguinal (CC-BY) ligament.

Case report

reconstructive surgeries and all other procedures performed in the femoral region, where the knowledge of the

So, this knowledge is of great help to cliniciansfemoral artery and surgeons. and PFA is important.

Abbreviations list -

DFA, deep femoral artery; LCFA, lat eral circumflex femoral artery; MCFA, medial circumflex femoral artery; ReferencesPFA, profunda femoris artery.

- 1. Standring S. Grays anatomy, 39th edn. 2.Philadelphia, Chummy SS. PA: Last’s Elsevier anatomy Churchill regional Liv andingstone; applied, 2005.pp.1450–2. 10th edn. UK: Churchill Liv-

- roningstone; F. Variational 1999.pp.114–5. anatomy of the deep 3. Siddharth P, Smith NL, Mason RA, Gi Figure 2: Branches of the femoral and profunda femoris arteries along with femoral artery. Anat Rec. 1985 Jun;- ations212(2):206–9. in the origin and course of pro- femoral vein. CFA, common femoral artery; FA, femoral artery; PFA, profunda 4. Dixit DP, Mehta LA, Kothari ML. Vari femoris artery; SEA,superficial epigastric artery; SEIA, superficial external iliac artery; DEIA, deep external iliac artery; MCFA, medial circumflex femoral artery;- fundafemoris. J Anat Soc India. 2001; dalLCFA, artery; lateral IL, circumflex inguinal ligament. femoral artery; ADGA, additional descending genicular 50(1):6–7. artery; SEPA, superficial external pudendal artery; DEPA, deep external puden 5. Sabnis AS. Anatomical variations of profunda femories Artery. J Clin Res Lett. important, as it is used in an osteo- 64 limbs10 2013;4(1):54–6. arose 6 cm distal to the origin of the 6. Lalović N, Maliś M, Korica M, Cvijanović R, Simatović M, Ilić M. Origin in mandibular reconstruction8 and in . In the present study, LCFA- of the medial circumflex femoral artery-a musculocutaneous flap, particularly8 . ditionally at this point, the profunda cadaver study. Med Glas (Zenica). 2013 - alsoPFA gave from rise its to lateral the muscular aspect and branch ad Aug;10(2):198–202. the vascularised iliac crest flap tery arises from the femoral artery and an additional descending genicu- 7. Ting JW, Rozen WM, Grinsell D, Stella- in The83.3% superficial of cases, circumflex from the deep iliac cirar- lar artery. DL, Ashton MW. The in vivo anatomy of- the deep circumflex iliac artery perfora Conclusion tors: defining the role for the DCIA perfo 6.6%cumflex of cases iliac inand 6.6% from of the cases, profunda from To the best of our knowledge these rator flap. Microsurgery. 2009 Mar;29(4):- femoristhe lateral in 3.3% circumflex of cases . femoral In the pre in- 326–9. - sent study, it was found 9to be arising 8. Tonoli C, Bechara AH, Rossanez R, Bel- from the profunda femoris, which is facts,variations the present are unique case and is of the high first sig of- angero WD, Livani B. Use of the vascular ized iliac-crest flap in musculoskeletal le yet another unique variation. its kind in the literature. With these- sions. BioMed Res Int. 2013 Oct;2013:1–6. - tions in hip joint replacement, clinical 9. Penteado CV. Anatomosurgical study of nated from the profunda femoris at proceduresnificance to such minimise as catheterisation, the complica the superficial and deep circumflex iliac In a previous study, the LCFA origi - repair of femoral hernia, surgical arteries. Anat Clin. 1983 May;5(2):125–7.- interventions for embolism, angiog- tions10. Prakash in the originsKumari ofJ, Kumarthe profundafemo Bhardwaj A,- an average of 2.5 cm distal to the ori- raphy, digital subtraction angiogra- risJose and BA, the Kumar medial Yadav and the S, Singhlateral G. femoral Varia edgin from of the the profunda femoral femorisartery at in an 52 aver out- of 64 (81.25%) limbs and it originat - of the profunda femoris in 12 out of phy, colour Doppler flow imaging, circumflex arteries: a cadaver study in age of 2.1 cm proximal to the origin osteomusculocutaneous flap, vascu the Indian population. Rom J Morphol larised iliac crest flap and vascular Embryol. 2010 Jan;51(1):167–70. Licensee OA Publishing London 2014. Creative Commons Attribution License (CC-BY)