Arteries+Veins+Lymphatics of the Lower Limb

Arteries in Abdomen

descending abdominal aorta A→divides into left+right common iliac A

Arteries in Pelvic Cavity (Divisions)

common iliac A divides into

• external iliac a

• internal iliac a

Branches of Internal Iliac Artery (General)+Lower Limb Suppliers

many branches

those that supply lower limb

• superior gluteal a

• inferior gluteal a

• obturator a

Branches of Internal Iliac Artery+Exit

superior gluteal a

inferior gluteal a

exits→pelvis via greater sciatic foramen

Superior Gluteal Artery (General)+Supplies

between gluteus maximus+gluteus medius

supplies

• gluteal muscles

• skin in gluteal region

• hip joint

anastomoses/connects with→medial+lateral circumflex femoral arteries+inferior gluteal a

Inferior Gluteal Artery (General)+Supplies

see it inferior to piriformis

deep to gluteus maximus

supplies

• gluteal region

• hip joint

Obturator Artery Exit+Enter

exits→pelvis via obturator canal through obturator foramenm

enters→medial compartment of thigh

Obturator Artery Supply

adductor muscles

adductor region of thigh

External Iliac Artery

within pelvic cavity

from branching off comon iliac a→inguinal ligament

at inguinal ligament→name change→femoral a

Inguinal Ligament

anterior superior iliac spine→pubic tubercle

Femoral Artery

from inguinal ligament→into femoral triangle→goes down femur

exits→adductor hiatus of adductor magnus→name change→popliteal a
-contains an inguinal ligament of adductor hiatus of adductor magnus

cannot see femoral a on posterior side of thigh

major artery supplying lower limb

many branches

gives rise to vessels that supply lower limb distal to knee

Profunda Femoris Artery

deep branch

• branches off of femoral a laterally

• deep to adductor longus

• superficial to adductor magnus

supplies

• adductors

• hamstrings muscles

gives rise to branches

terminates→by piercing adductor magnus

Branches off Profunda Femoris Artery

circumflex a

• lateral circumflex femoral a

• medial circumflex femoral a

• perforating a (usually 3)

Lateral Circumflex Femoral Artery

arises off→lateral aspect of profunda femoris a
-sometimes femoral a

deep to

• sartorius

• rectus femoris

multiple branhces off it

collectively supplies

• head+neck fo femur

• tensor fasciae latae

• rectus femories

• vastus lateralis

anastomoses/connects with medial circumflex femoral a

Medial Circumflex Femoral Artery

arises off→posteromedial aspect of profunda femoris a
-sometimes femoral a

multiple branches off it

supplies

• pectineus

• ilipsoas

• obturator externus

• adductor brevis

anastomoses/connects with lateral circumflex femoral a

Branches off Profunda Femoris Artery

can see then on psoterior side on thigh

3 perforating arteries

1. emerges above adductor brevis

2. anterior to adductor brevis

3. below

all pierce adductor magnus→supply posterior compartment of thigh

last visible artery on posterior side→terminal branch of profunda femoris a (not a perforating a)

Femoral Artery

from inguinal ligament→into femoral triangle→down femur deep to sartorius→enters adductor hiatus

-femoral a pops through adductor hiatus to posterior side of thigh→name change→popliteal a

Popliteal Artery

after femoral a passes throguh adductor hiatus→name change to popliteal a

posterior side of femur→near popliteals surface

from adductor hiatus of adductor magnus→division inferior to knee joint

divides into

• anterior tibial a

• posterior tibial a

supplies→genicular arteries

Genicular Branches Artery

multiple small branches off popliteal a

anastomoses/connects around knee

primary blood supply→knee joint

• bones

• ligaments

• tendons

• muscles

Anterior+Posterior Tibial Arteries

inferior to knee joint

• only small section of anterior tibal a visible in posterior view

• see full extent posterior tibial a well in posterior view

popliteal a divides to form anterior+posterior tibia as

Anterior Tibial Artery

division from popliteal a→heads off laterally→passes through the interosseous membrane→anterior compartment of lower leg→towards dorsal surface of foot

found in anterior compartment→deep to tibialis anterior

runs between tibia and fibula

runs towards the dorsal surface of foot

runs with deep fibular nerve

supplies blood to anterior compartment

gives rise to vessels supplying dorsal surface of foot

Dorsalis Pedis Artery

anterior tibial a→crosses ankle→dorsal side of foot→name change→dorsalis pedis a

on dorsal side of foot

gives rise to

• arcuate a

• dorsal metatarsal as

• dorsal digital as
  -supply digits 1-5

Posterior Tibia Artery

division from popliteal a

posterior side of leg→runs along tibialis posterior→goes along medial malleolus→to plantar side of foot

deep to

• gastrocnemius

• soleus

on plantar side of foot
divides into:

• medial plantar a

• lateral plantar a→gives rise to deep plantar arch a

supplies

• posterior compartment of lower potion of leg

• lateral compartment of lower portion of leg

gives rise to branches supplying plantar surface of foot

Plantar+Metatarsal+Digital Arteries

branches off deep plantar arch

seen between metatarsals

gives rise to digital arteries for digits 1-5

Fibular Artery

branhces off the posterior tibial a

runs along fibula to the heel

supplies

• fibularis longus

• fibularis brevis

• in lateral compartment

Arteries of the Leg Pathway

abdominal aorta divides into

• left common iliac a

• right common iliac a

L+R common ilia as divide into

• internal iliac a

• external iliac a

internal iliac a branches

• superior gluteal a

• inferior gluteal a

• obturator a

• all supply lower limb

Superior+Inferior Gluteal Arteries

through the greater sciatic foramen

piriformis→guide muscle

• superior gluteal a→superior to piriformis

• inferior gluteal a→inferior to piriformis

Venae Comitantes

arteries and veins that run together

same name

examples

• common iliac A+V

• external iliac A+V

• internal iliac A+V

• popliteal A+V

• anterior tibial A+V

• posterior tibial A+V

• femoral A+V

Veins of the Leg Pathways

remember: veins follow blood to the heart

external iliac v

1. fibular v runs along fibula
   -with fibular a

2. drains into posterior tibial v inferior to knee joint
   -runs with posterior tibial a

3. anterior tibial v in anterior compartment
   -with anterior tibial a

4. anterior tibial v joins posterior tibial v→form popliteal v
   -runs with popliteal a in popliteal fossa
   -posterior surface of knee joint to adductor hiatus of adductor magnus

5. superior adductor hiatus→name change→femoral v
   -runs with femoral a
   -on anterior side of thigh

6. femoral v runs from superior to adductor hiatus→under inguinal ligament
   -runs with femoral a

7. femoral v runs superior to inguinal ligament→name change→external iliac v
   -runs with external iliac a

internal iliac v

1. superior+inferior gluteal vs drain the gluteal regions
   -run with superior+inferior gluteal as

2. both enter pelvis via greater sciatic notch

3. drain into internal iliac v (with other vessels)
   -runs with internal iliac a

common iliac v→inferior vena cava v

1. both internal+external vs join→form common iliac v
   -runs with common iliac a

2. both common iliac vs joint→form inferior vena cava v
   -lateral to abdomninal aorta

Unpaired Veins

no artery counterpart

superficial vs

• great saphenous v

• small saphenous v

Great Saphenous Vein

no artery counterpart→equivalent to cephalic v

anterior to medial malleolus of tibia→posteromedial surface of calf→crosses around knee→up medial side of thigh→joints femoral v within femoral triangle (superficial to fascial layer)

drains dorsal surface of foot

Small Saphenous Vein

no artery counterpart

behind lateral malleolus of fibula→up posterior surface of the calf→joins popliteal v

Coronary Bypass Surgery Pathophysiology

heart has own arteries supplying oxygenated blood to heart muscles→L+R coronary as

coronary as can become blocked
-plaques→less oxygen getting to heart muscle

“bypass”→blockage in actual artery is bypassed

Coronary Bypass Surgery Process

create new “coronary artery” with great saphenous v

1. remove portion of great saphenous v near medial malleolus

2. attach to aorta

3. carries oxygenated blood from aorta to heart muscle

v can act as artery

• large v

• not far to travel

Passageways in Lower Limb

areas of transition from one area to another

• a+v+n

• femoral triangle

• adductor canal

• popliteal fossa

Femoral Triangle

formed by

• inguinal ligament

• adductor longus

• sartorius

houses (lateral→medial)

• femoral n

• femoral a

• femoral v

• inguinal lymph nodes

acronym→”a NAVL ship sails across the bermuda triangle”

Adductor Canal

apex is continuous with adductor canal

vessels run through adductor canal

descends medially down thigh→posteriorly through adductor hiatus→popliteal fossa of knee

Popliteal Fossa

diamond-shaped space

posterior to knee joint

area of transition between thigh+lower portion of leg

formed by muscles

• medially
  -semitendinosus
  -semimembranosus

• laterally→biceps femoris

• distally
  -gastrocnemius
  -plantaris

contains

• popliteal a

• popliteal v

• tibial n

• common fibular n

Lymphatic System (General)

complex network of channels+vessels

responsible for collecting interstitial fluid from body→returning it to venous side of vascular system

lymph nodes

• superficial inguinal lymph nodes

• external iliac lymph nodes

• popliteal lymph nodes

Lymphatic System Pathway

responsible for collecting interstitial fluid from body→returning it to venous side of vascular system

flows in one direction

filtered by lymph nodes

predictable pattern starting with:

1. porous lymphatic capillaries of tissues

2. converge into larger vessels

3. feed into lymph nodes

4. large lymphatic vessels→connect to veins in neck

Lymphatic Capillaries

responsible for collecting interstitial fluid

• fluid lost from capillary beds during nutrient exchange

• surplus tissue fluid

• leaked plasma proteins

• pathogens

• cell products

• cell debris

• cells of lymphatic system

collected fluid=lymph

Lymphatic Vessels

from lymphatic capillaries→lymph sent to larger lymph vessels→delivered to lymph nodes

lymph vessels

• throughout the body

• thin-walled vessels

Lymph Nodes (General)

masses of lymphatic tissue

contain cells of immune system

• lymphocytes

• macrophages

• destroy viruses+bacteria

filter

lymph:

• antigens

• pathogens

if lymph from infected region is filtered by lymph node

• rapid cell turnover

• production of inflammatory mediators

• enlarged+tender lymph node→superficial nodules palpated for sign of infection

Lymph Node Areas in Body

groin→inguinal lymph nodes

femoral vein→femoral lymph node

axilla of upper arm→axillary lymph nodes

neck

along trachea+bronchi

aorta+branches of abdomen