Arterial Supply of the Lower Limb Dr. Nivin ~Sharaf MD LMCC.
Arterial Supply of the Lower Limb
-
Upload
odysseus-emerson -
Category
Documents
-
view
16 -
download
1
description
Transcript of Arterial Supply of the Lower Limb
![Page 1: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/1.jpg)
Arterial Supply of the Lower Limb
![Page 2: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/2.jpg)
ObjectivesDescribe Anastomoses around: Hip, Knee
and ankle jointsEnumerate the most important branches,
and recognize the course of : Femoral, popliteal, Anterior tibial, and posterior tibial arches
Formation of the Dorsal and Plantar archesDifferentiate between superficial and deep
venous systemRecognize the importance of the valves in
the circulatory systemBe 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
![Page 3: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/3.jpg)
Blood supply to lower limbRight 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, and Internal Iliac Arteries
![Page 4: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/4.jpg)
Blood supply to lower limb
Frolich, Human Anatomy, Lower LImb
Internal Iliac Superior & Inferior Gluteal arteries
Obturator artery
External Iliac Femoral artery
• Deep femoral = adductors, hamstrings, quadriceps
Popliteal (continuation of femoral) • Geniculars = knee• Anterior Tibial = ant. leg muscles,
further branches to feet• Posterior Tibial = flexor muscles,
plantar arch, branches to toes
![Page 5: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/5.jpg)
Internal Iliac Artery- Obturator artery “ leaves the
pelvis through the obturator canal”
- Inferior Gluteal artery” leaves through the greater sciatic foramen inferior to Piriformis”
- Superior Gluteal artery” leaves through the greater sciatic foramen superior to Piriformis”
![Page 7: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/7.jpg)
![Page 8: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/8.jpg)
Obturator ArteryArises from internal iliac in pelvis:
Enters thigh through obturator canal.Accompanied by anterior/posterior obturator nerve branches.
Gives rise to:Anterior and posterior
branches.Acetabular artery:
To head of femur via ligamentum teres
![Page 9: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/9.jpg)
![Page 10: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/10.jpg)
Superior gluteal arteryOrigin: continuation of
post division of internal iliac artery.
Course and distribution:
-passes out through greater sciatic foramen above Piriformis.
-divides into sup and deep branches to supply glutei.
![Page 11: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/11.jpg)
Inferior gluteal artery
Origin: one of 2 terminal branches of ant division of internal iliac artery.
Course and distribution: -passes out through
greater sciatic foramen below Piriformis.
Distribution: Muscular branches.
![Page 12: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/12.jpg)
Trochanteric anastomosis
Formed by:1. Branch of superior
gluteal artery.2. Inferior gluteal artery. 3. Ascending branch of
medial circumflex artery.
![Page 13: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/13.jpg)
Cruciate anastomosis Formed by:1. Inferior gluteal
artery.2. Medial femoral
circumflex artery3. Lateral femoral
circumflex artery4. First perforating
artey
![Page 14: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/14.jpg)
Branches of ExternalIliac artery
![Page 15: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/15.jpg)
Femoral Artery
Femoral artery is the continuation of the external iliac artery:
Begins deep to the inguinal ligament. Enclosed within the femoral sheath. Becomes the popliteal artery: At the adductor hiatus. Proximal branches:
Superficial epigastric artery. :Anastomoses with inferior epigastric artery.
Superficial circumflex iliac artery: Anastomoses with deep circumflex iliac artery.Superficial external pudendal artery.
Passes medially toward external genitalia.
Dr. Iman Abdel Aal
![Page 16: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/16.jpg)
Femoral Artery
![Page 17: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/17.jpg)
Femoral Artery “deep branches”Deep branches:
Deep external pudendal.Descending genicular.
Profunda femoris (deep femoral) Arises from deep of femoral artery within
femoral triangle.Largest branch of femoral artery.Passes posterior to adductor longus
muscle.Branches:” of Profunda femoris”
Medial femoral circumflex.Lateral femoral circumflex.Perforating arteries (3).Descending genicular.
![Page 18: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/18.jpg)
Femoral artery Cont.The femoral artery enters the
adductor canal to pass to the posterior compartment of the knee “popliteal fossa” and changes it’s name to popliteal artery
It is accompanied by popliteal vein which runs in the lateral side of the artery
![Page 19: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/19.jpg)
Popliteal artery
Origin: Continuation of
femoral art as it passes through opening in adductor magnus muscle.
Course: from its origin it
runs downwards & slightly laterally in popliteal fossa
![Page 20: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/20.jpg)
Popliteal artery
Reaches lower border of popliteus
Terminates by dividing into ant & post tibial arteries
![Page 21: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/21.jpg)
Branches1. Muscular: supplies
surrounding muscles
2. Articular(genicular):
-lateral & medial superior genicular
-middle genicular
-lateral & medial inferior genicular
![Page 22: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/22.jpg)
Anastomosis around the knee
Branches of femoral artery
Popliteal(muscular&
articular)Anterior &
posterior tibial arteries
![Page 23: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/23.jpg)
Blood Supply of the anterior Compartment of the LegAnterior Tibial Artery The anterior tibial artery is
the smaller terminal branches of the popliteal artery.
It arises at the level of the lower border of the popliteus muscle and passes forward into the anterior compartment of the leg through an opening in the interosseous membrane.
It descends on the anterior surface of the interosseous membrane,
![Page 24: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/24.jpg)
![Page 25: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/25.jpg)
Anterior Tibial Artery In front of the ankle joint, the artery
becomes the dorsalis pedis artery.
![Page 26: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/26.jpg)
Anterior tibial artery & nerve
![Page 27: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/27.jpg)
Anterior Tibial ArteryBranchesMuscular branches to neighboring
muscles.Anastomotic branches that
anastomose with branches of other arteries around the knee and ankle joints.
Venae comitantes of the anterior tibial artery join those of the posterior tibial artery in the popliteal fossa to form the popliteal vein.
![Page 28: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/28.jpg)
![Page 29: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/29.jpg)
![Page 30: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/30.jpg)
![Page 31: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/31.jpg)
Artery of the Posterior Fascial Compartment of the Leg
Posterior Tibial Artery
The posterior tibial artery is one of the terminal branches of the popliteal artery.
It begins at the level of the lower border of the popliteus muscle and passes downward deep to the gastrocnemius and soleus and the deep transverse fascia of the leg.
![Page 32: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/32.jpg)
Artery of the Posterior Fascial Compartment of the Leg
Posterior Tibial Artery
It lies on the posterior surface of the tibialis posterior muscle above and on the posterior surface of the tibia below.
The artery passes behind the medial malleolus deep to the flexor retinaculum and terminates by dividing into medial and lateral plantar arteries.
![Page 33: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/33.jpg)
![Page 34: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/34.jpg)
Artery of the Posterior Fascial Compartment of the Leg
Branches
Peroneal artery: It is a large artery that arises close
to the origin of the posterior tibial artery.
The peroneal artery gives off muscular branches and a nutrient artery to the fibula and ends by taking part in the anastomosis around the ankle joint.
![Page 35: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/35.jpg)
![Page 36: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/36.jpg)
Lateral Plantar ArteryThe lateral plantar artery is the larger terminal branch of the posterior tibial artery. At the base of the 5th metatarsal bone, the artery curves medially to form the plantar arch and at the proximal end of the first intermetatarsal space joins the dorsalis pedis artery. During its course, it gives off muscular, cutaneous, and articular branches. The plantar arch gives off plantar digital arteries to the toes.
![Page 37: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/37.jpg)
![Page 38: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/38.jpg)
Venous Drainage
![Page 39: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/39.jpg)
Venous drainage of the lower limb.
Superficial and Deep veins: The superficial veins are between the
two layers of superficial fascia while the deep veins accompany the arteries.
Both sets of veins are provided with
valves more numerous in the deep than in the superficial set.
![Page 40: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/40.jpg)
Small saphenous vein ( short saphenous vein) Begins behind the lateral malleolus as a continuation of the lateral marginal vein.
Ascends to reach the middle of the back of the leg.
It perforates the deep fascia at the popliteal fossa.
Ends in the popliteal vein. It has 9-12 valves
Tributaries -Branch from great
saphenous vein -Lateral marginal vein
- Numerous tributaries from the back of the leg.
![Page 41: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/41.jpg)
The great saphenous vein (long saphenous vein) The longest vein in the body.
Begins in the medial marginal vein of the dorsum of the foot
Ends in the femoral vein about 3 cm below the inguinal ligament.
It passes in front of the medial malleolus and along the medial side of the leg behind the medial condyles of the tibia and femur and along the medial side of the thigh to end in the femoral vein.
It possesses 10-20 valves.
Tributaries:-medial marginal vein-numerous cutaneous vein-superficial circumflex iliac
-superficial external pudendal also communicates with anterior and
posterior tibial veins and the small saphenous vein
![Page 42: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/42.jpg)
Deep veins They accompany the arteries and their branches.
They possess numerous valves. The deep plantar venous arch lies alongside the plantar arterial arch drains into the medial and lateral plantar veins
The posterior tibial vein accompanies the posterior tibial artery and joined by the peroneal vein.
The anterior tibial vein is the upward continuation of the venæ comitantes of the dorsalis pedis artery. They leave the front of the leg by passing between the tibia and fibula, over the interosseous membrane, and unite with the posterior tibial vein to form the popliteal vein.
![Page 43: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/43.jpg)
Popliteal veinFormed by union of
venae comitantes of ant, post tibial arteries.
At the lower border of popliteus.
Continues as femoral vein at adductor opening.
TRIBUTARIES: 1- Veins accompany
arteries. 2- Small saphenous v.
![Page 44: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/44.jpg)
The femoral vein accompanies the
femoral artery through the upper 2/3rd of the thigh. It receives many muscular tributaries, and about 4 cm below the inguinal ligament is joined by the deep femoral vein and is joined by the great saphenous vein before it terminates. The deep femoral vein receives tributaries corresponding to the perforating branches of the profunda artery. It also receives the medial and lateral femoral circumflex veins.
![Page 45: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/45.jpg)
![Page 46: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/46.jpg)
![Page 47: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/47.jpg)
Veins of the sole of the footVeins of the Sole of the Foot:Medial and lateral plantar veins
accompany the corresponding arteries, and they unite behind the medial malleolus to form the posterior tibial venae commitantes
![Page 48: Arterial Supply of the Lower Limb](https://reader036.fdocuments.us/reader036/viewer/2022062408/568130d6550346895d96eacf/html5/thumbnails/48.jpg)
Thank you