Dr Francois du Toit Department of Diagnostic Radiology

Dr. Francois du Toit Department of Diagnostic Radiology Kimberley Hospital Complex Blood Supply of the Lower Limb

ARTERIES OF THE LOWER LIMB

Arteries of the Lower Limb �Ext Iliac Common Fem ▪ Crosses under Inguinal Ligament �BRANCHES ▪ Superficial Circumflex Femoral a. ▪ Superficial Inferior Epigastric a. ▪ Superficial Pudendal a. �Profunda �Common Femoris a. (biggest branch) Femoral Superficial Femoral a.

External Iliac Artery Inguinal Ligament Common Femoral Artery Profunda Femoris Artery Superficial Femoral Artery

Profunda Femoris Artery �Biggest Branch of Common � 5 cm distal to Ing. Ligament � 6 BRANCHES ▪ 2 Circumflex Femoral �Medial �Lateral ▪ 4 Perforating Arteries (4) Femoral a.

Circumflex Femoral aa. �Form ring around upper Femur �Lateral Circumflex has 2 branches ▪ Ascending branch than anastomoses with superior gluteal a. ▪ Descending branch to the knee

Perforating aa. �Supply muscles of thigh �Surround Femur �Last is continuation of Profunda a.

Profunda Femoris Lateral Circumflex Perforating arteries

Superficial Femoral Artery �Passes in Adductor Canal ▪ Between Vastus Med / Adductors / Sartorius �Through Adductor Hiatus ▪ At junction of upper 2/3 and lower 1/3 of femur ▪ Into Popliteal Fossa Popliteal Artery �Just before this – descending branch to genicular anastomosis

Adductor Brevis Adductor Magnus Superficial Femoral Vastus Medialis Sartorius Lateral Superior Genicular Artery Popliteal Artery

Popliteal Artery �Branches to Genicular Anastomosis and Knee Joint �Divides at lower border of Knee Joint ▪ Posterior Tibial artery (which gives off Peroneal a. ) ▪ Anterior Tibial artery

Popliteal Artery Inferior Lateral Genicular Artery Anterior Tibial Artery Tibioperoneal Trunk Peroneal Artery Posterior Tibial Artery

Posterior Tibial Artery �Larger of the two � 2. 5 cm from its origin Peroneal a. �Then descends and becomes more �At the ankle medial ▪ Medial malleolar branch �Then passes posterior to medial malleolus ▪ Halfway between tip of malleolus and midline ▪ Branches medial and lateral plantar aa (the principal supply of the foot)

Posterior Tibial Artery Medial Malleolus

Peroneal Artery �Descends to lie posteromedially of the fibula �Runs behind tibiofibular joint �Ends as Calcaneal Branch

Peroneal Artery Calcaneal Branch of Peroneal artery

Anterior Tibial Artery �Passes above upper margin of interosseus membrane �Descends anterior to membrane �Becomes superficial at ankle midway between malleoli �Continues as Dorsalis Pedis Artery ▪ Passes between 1 st and 2 nd metatarsals to join plantar arch

ANTERIOR KNEE POSTERIOR KNEE Anterior Tibial Artery

Anterior Tibial Artery Dorsalis Pedis Artery

VEINS OF THE LOWER LIMB

Veins of the Lower Limb �Superficial System ▪ Long & Short Saphenous �Deep System ▪ Accompany Arteries �Normal �Valves direction = Superfical Deep Superficial > Deep Distal > Proximal

Superficial System �Long (Great) Saphenous Starts on medial side of dorsum of foot Passes anterior to medial malleolus Ascends to ▪ posterior side of medial knee ▪ anterior side of medial upper thigh Drains to Femoral vein

Great Saphenous Vein

Great Saphenous Vein in anteromedial thigh Great Saphenous Vein in Posteromedial knee

Great Saphenous Vein Femoral Vein

… Superficial System �Short Saphenous Begins lateral side of dorsum of foot Passes posterior to lateral malleolus Ascends on back of calf Pierces deep fascia over popliteal fossa Drains to Popliteal Vein

Short Saphenous

Lateral Superior Genicular Vein Popliteal Vein Small (Short) Saphenous Vein

Deep System �Accompany �Usually Arteries paired … BUT may be more than two veins that accompany each artery

Perforating (communicating) vv. �Connects Superficial to Deep vv. �Variable in site and number �>2 in medial aspect of lower leg above ankle �Also found in medial aspect of lower thigh

References � Anatomy for Diagnostic Imaging 3 rd Edition, Stephanie Ryan � 3 D Human Anatomy Atlas Version 2, Argosy Publishing � http: //www. imaios. com/