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VascularSupply of the Lower Limb CraigGordon cgordon24@qub.ac.ukLearningOutcomes • Describe the arterial supply and venous drainage of the lower limb • Identify the great and short saphenous vein • Identify the femoral vein • Identify the popliteal vein • Identify the femoral and profunda femoris arteries and describe the origin, course and relations of these vessels • Identify the popliteal artery and describe the origin, course and relations of this vessel • Identify the anterior tibial and fibular arteries and describe the origin, course and relations of these vessels • Identify the posterior tibial artery and describe the origin, course and relations of this vessel • Identify the medial and lateral plantar arteries and describe the origin, course and relations of these vesselsVenous Drainage of the Lower Limb •Drainageto externaliliacvein •Consists ofsuperficialanddeepveins •Deepveinshavethesamenamesasthe arteries theytravel with •Share fibrous sheathwitharteries- pulsations result invenous returntothe heartSuperficialVeins • Small saphenous veinoriginates posterior to the lateral malleolus, ascendsposterolaterallyand empties into the popliteal vein in pop. fossa • Great saphenous vein originates anterior to the medial malleolus, ascends medially, passes through saphenous opening in fascia lata and drains into femoral vein VaricoseVeins • Caused by incompetent valves in perforating veins; blood pools in superficial veins • Presentation:heavy legs, itching, oedema, signs of chronic venous insufficiency (skin changes and ulceration) • Risk factors:older age, female, pregnancy, obesity,prolonged standing • Surgical options (after conservative Varicosegreat saphenous vein, the most affectedvein management): • Endothermal ablation • Sclerotherapy • StrippingHaemosiderin deposition in legs with chronic venous insufficiencyDeepVeins •medial and lateral plantar veins unite to formposterior tibial vein •Anterior and posterior tibial veins unitewith fibular vein to form popliteal vein •Popliteal vein become fsmoral vein in the thigh •Femoral vein is continuous with external iliac vein Popliteal Vein FemoralVein • Formedbytheunionoftheant/posteriortibialveinsegins atadductor hiatus, becomes externaliliac andthefibularvein inferior toiliac ligament • Runs posterior to knee in the popliteal fossaravels indductor canal • Receivesgreat saphenous veinand profunda femoris veinDeepVeinThrombosis • Thrombusformsindeepveinsdue tohypercoagulablestate • RiskFactors:recentsurgery, immobility,long-haul travel, pregnancy,oestrogenhormone therapy,thrombophilia • Potential for thrombus to embolise towardspulmonarycirculation, causingapulmonary embolismArterialSupply of the Lower LimbFemoralArtery • Continuationofthe external iliacartery inferior to the inguinal ligament • Entersfemoraltrianglehalfwaybetween ASIS/pubictubercle • Formsfemoralsheathwithfemoralvein (not the nerve) • VANmedial to lateral • Travels in adductor canal, deep to sartorius • Becomespoplitealarteryat adductor hiatusFemoral artery branches • Profunda femoris artery:from posterolateral femoral artery.Supplies femur,v.lateralis,hamstrings via perforatingarteries • Medial circumflex femoral artery: suppliesheadandneckoffemur • Damageduring#NOFresultsinAVN of femoral head • Lateral circumflex femoral artery NB: MCFA/ LCFA are usually branches of the profunda femorisa.buttheycancome directlyfromthe femorala. Popliteal Artery • Continuation of the femoral artery at the adductor hiatus • Gives genicular branches, forming peri- articular anastomosis • Travels deep in the posterior aspect of the knee in the popliteal fossa • Exits at the lower border of gastrocnemius and popliteus • Once exitingthe popliteal fossa, becomesanterior tibial artery and tibial-fibial trunkAnteriorTibialArtery • Smaller terminal branch of popliteal artery • Begins at inf. border popliteus m. • Supplies structures in the anterior compartment of the leg • Passes anteriorly through interosseous membrane, traveling inferiorly between TA & EDL mm . • Becomesdorsalis pedis artery Posterior Tibial Artery •Largestterminal branchofthepopliteal artery •Supplies posteriorcompartment oflegandthe foot •Travels on posterior surface of tibialis posterior •Runsposterior to medial malleolus,deeptoflexor retinaculum (in tarsal tunnel) •Dividesinto medial and lateral plantar arteriesFibularArtery • Arises from tibial-fibial trunk, inferior to the distal border of popliteus • Descends laterally towards the fibula in the posterior compartment of the leg •Supplies the lateral compartment via perforating branches- arteries that perforate intermuscular septumArterialSupply of theFoot • Dorsalispedisartery:from ant. tib. a., runs lateral toEHL in 1 intertarsal groove • Contributes todeepplantararchvia deepplantarartery • FormsM&Ltarsalaa. • Medialplantarartery:from post. tib. a. • Supplies big toe • Lateral plantarartery:from post. tib. a. • Also contributes to deep plantar archPulses of the Lower Limb • Femoral pulse:inferior to way betweenASIS and(1/2 pubic tubercle) • popliteal fossa with flexed knees • Dorsalis pedis pulse: distal to the prominencen, of the navicular bone • posterior to the medial malleolus