The importance of the deep femoral artery in repeated reconstructions

Great artery of the thigh

Femoral artery

the large artery in the thigh and the main source of arterial up to the thigh and lower leg. The femoral artery gives off the deep femoral artery or deep femoral artery and descends along the anteromedial aspect of the thigh at the femoral triangle. It enters and passes through the adductor canal and becomes the popliteal artery when it passes through the adductor bridge in the adductor magnus muscle near the junction of the middle and distal thirds of the thigh. [1]

Structure [edit]

The femoral artery enters the thigh from behind the inguinal ligament as a continuation of the external iliac artery. [2] Here it is located midway between the anterior superior iliac spine and the pubic symphysis.

Its first three to four centimeters, together with the femoral vein, are enclosed in the femoral sheath.

Relationships [edit]

Due _

femoral artery are as follows:

• In front:
  in the upper part there is a superficial layer covered with skin and fascia. At the bottom of its course it passes behind the sartorius muscle.
• Posteriorly:
  the artery lies on the psoas muscle, which separates it from the hip joint, pectoralis muscle and adductor longus muscle. The femoral vein passes between the artery and the long adductor muscle.
• Medially:
  connected with the femoral vein in the upper part of its course.
• Lateral view:
  femoral nerve and its branches.

Branches [edit]

Diagram of the femoral arteries, including the branches of the femoral artery.

The femoral artery gives off several branches

in the thigh, which include:

• The superficial circumflex iliac artery
  is a small branch that passes to the region of the anterior superior iliac spine.
• The superficial epigastric artery
  is a small branch that crosses the inguinal ligament and runs to the umbilicus.
• The superficial external pudendal artery
  is a small branch that passes medially to supply the skin of the scrotum (or labium majus).
• The deep external pudendal artery
  passes medially and supplies the skin of the scrotum (or labium majus).
• The profunda femoral artery
  is a large and important branch which arises from the lateral side of the femoral artery about 1.5 inches. (4 cm) below the inguinal ligament. It passes medially behind the femoral vessels and enters the medial fascial compartment of the thigh. At the end it becomes the fourth perforating artery. Initially, it identifies the medial and lateral circumflex femoral arteries, and along the way - three perforating arteries.
• The descending genicular artery
  is a small branch that arises from the femoral artery near its termination within the adductor canal. It helps supply the knee joint.

Segments[edit]

Sections of the femoral artery.

In clinical terms, the femoral artery consists of the following segments:

• The common femoral artery
  is the segment of the femoral artery between the inferior edges of the inguinal ligament and the branching point of the deep femoral artery.
• The subsartorial artery
  [3] or
  superficial femoral artery
  [4] is to designate the segment between the branch point of the deep femoral artery and the adductor hiatus, passing through the subsartorial canal.
  However, many doctors discourage the use of the term " superficial femoral
  " because it leads to confusion among general practitioners, at least regarding the femoral vein, which runs adjacent to the femoral artery.
  [5] In particular, the adjacent femoral vein is clinically a deep vein, the thrombosis of which is indicated by anticoagulant or thrombolytic therapy, but the adjective "superficial"
  causes many physicians to mistakenly believe that it is a superficial vein, leading to patients with femoral thrombosis being denied proper treatment.
  [6] [7] [8] Thus, the terms subartorial artery
  and
  subartorial vein
  have been proposed for the femoral artery and vein, respectively, distal to the branching points of the deep femoral artery and vein. [3]

Arterial thrombosis - symptoms and treatment

Arterial thrombosis is a sudden, acute cessation of arterial blood flow caused by a thrombus blocking a blood vessel. Thrombus (from ancient Greek - lump, clot) is an intravital blood clot that forms during diseases or injuries. Normally, the circulatory system does not contain blood clots. Their appearance in the vessel threatens the patient’s life.

Arteries are blood vessels that carry oxygenated blood from the heart to the limbs, organs and tissues. Arterial thrombosis leads to a sudden cessation or deterioration of arterial blood flow in a limb or organ with a potential threat to its viability [1].

Arterial thrombosis in 40% of cases causes acute limb ischemia (lack of blood supply), and in 37% - embolism [2][3]. Embolism (from Greek - invasion) is the separation of a blood clot from the site of its initial formation, or the transfer of a pathological substrate with the bloodstream along the vascular bed with subsequent blockage of an arterial vessel. The pathological substrate can be solid, liquid or gaseous formations: drops of fat, gas or air bubbles, masses from a “burst” cholesterol plaque, pus, etc.

Arterial thrombosis and embolism cannot be considered independent diseases. They always arise as a consequence of other pathological conditions.

The causes of a blood clot in the lumen of a vessel are described by the German scientist Rudolf Virchow. They are united in the well-known triad:

1. Damage to the vascular wall.
2. Slowing blood flow.
3. Violation of blood composition.

A thrombus is formed under the influence of all three factors with dominance of one of them.

Damage to the vascular wall is caused by:

• injuries - mechanical, thermal, electrical, etc.;
• inflammatory diseases of the arteries - arteritis, obliterating atherosclerosis with the development of atherothrombosis;
• severe infectious diseases - typhus, influenza, sepsis.

Slow blood flow occurs in the following cases:

• extravasal compression - compression of a vessel from the outside by a tumor, effusion of blood, an additional cervical rib, a bone fragment during a fracture, mechanical pressure during accidents, etc.;
• aneurysms (dilation of blood vessels);
• arterial spasms;
• acute circulatory failure;
• prolonged immobilization of limbs;
• oncological diseases.

to disturbances in blood composition [11]:

• blood diseases - leukemia, erythrocytosis, polycythemia;
• significant dehydration of the body;
• hereditary or acquired thrombophilia (pathological thrombus formation);
• systemic atherosclerosis;
• diabetes;
• hypertonic disease;
• malignant neoplasms;
• endotoxemia (accumulation of toxic breakdown products and bacterial activity in the blood and tissues);
• states of shock;
• taking medications - glucocorticosteroids, estrogens and gestagens (hormone replacement therapy and combined oral contraceptives), hemostatic agents, antifibrinolytic agents.

Emboli can be caused by heart disease or other causes.

Cardiac causes of embolism:

• cardiac ischemia;
• myocardial infarction;
• post-infarction cardiosclerosis;
• post-infarction aneurysms of the left ventricle;
• rheumatic heart defects;
• septic bacterial endocarditis;
• heart tumors (myxomas).

In these cases, a blood clot forms in the cavities of the heart. Then, under the influence of a hypertensive crisis, changes in heart rhythm and other reasons, its defragmentation occurs. The thrombus rushes with the blood flow, blocks a section of the arterial bed of a smaller diameter or a fork in the area of ​​​​the division of the vessel.

Noncardiac causes:

• aortic aneurysm;
• ulcerated arterial plaques;
• pneumonia;
• lung tumor.

In rare cases, paradoxical embolism is possible - migration of a blood clot from the venous system through the right side of the heart to the left. This occurs with congenital heart disease and embolism with foreign objects (for example, a bullet or shot) [4].

The incidence of acute limb ischemia is one case per 6000 people annually [12]. With age, the incidence increases sharply. In the vast majority of cases, the pathology affects people over 60 years of age [8]. Ischemia, which occurs as a complication of thrombosis, more often affects men than women.

Smoking, an inactive lifestyle and poor nutrition lead to the development of atherosclerosis, hypertension and diabetes. At the same time, the risk of developing arterial thrombosis also increases.

The individual risk of vascular pathology includes:

• age younger than 50 years in the presence of diabetes mellitus and one of the risk factors for atherosclerosis: smoking, dyslipidemia (impaired lipid ratio in the blood serum), hypertension, hyperhomocysteinemia (increased level of the amino acid homocysteine ​​in the blood);
• age 50-69 years and presence of diabetes mellitus or smoking;
• age 70 years and older [8].

Clinical significance[edit]

Pulse[edit]

Because the femoral artery can often be palpated through the skin, it is often used as the artery for catheter access. From here, wires and catheters can be directed to any location in the arterial system for intervention or diagnosis, including the heart, brain, kidneys, arms and legs. The direction of the needle in the femoral artery can be against the flow (retro-level), for intervention and diagnosis towards the heart and the opposite leg, or with the flow (pre-degree or ipsi-lateral) for diagnosis and intervention on the same leg. Access to both the left and right femoral artery is possible and depends on the type of intervention or diagnosis. [ citation needed

]

Place for optimal pulse

on the thigh is located on the inner side of the thigh, at the mid-groin point, halfway between the pubic symphysis and the anterior superior iliac spine.
The presence of a femoral pulse
is estimated to indicate a systolic blood pressure greater than 50 mmHg, as determined by the 50% percentile. [9]

The femoral artery can be used to collect arterial blood when the blood pressure is so low that the radial or brachial arteries cannot be detected.

Peripheral artery disease[edit]

The femoral artery is susceptible to peripheral artery disease. [10] When it is blocked by atherosclerosis, percutaneous intervention with access from the opposite femur may be required. Endarterectomy, surgical dissection and removal of the femoral artery plaque, is also common. If the femoral artery must be surgically ligated to treat a popliteal aneurysm, blood may still reach the popliteal artery distal to the ligation through the knee anastomosis. However, if blood flow in the femoral artery of the healthy leg is suddenly interrupted, distal blood flow is rarely sufficient. The reason for this is that the knee anastomosis is only present in a minority of people and is always undeveloped when femoral artery disease is absent. [eleven]

Treatment of femoral artery aneurysm

Conservative treatment in the presence of an aneurysm is not carried out. With the help of medications, you can only delay the rupture of the artery wall by using antihypertensive drugs. The optimal treatment option is surgery. The main types of surgical interventions are presented in the table.

• Where is the carotid artery located and what is its role in the human circulatory system?

If the size of the operation is small and the risk is high, a wait-and-see approach may be chosen. In this case, physical overexertion is contraindicated for the patient; medications are prescribed to maintain normal blood pressure and prevent blood clots. Such patients should be regularly examined and observed by a vascular surgeon.

History[edit]

Teaching illustrations of knee anastomosis, such as the one shown in the side box, appear to have been taken from an idealized image first created by Gray's Anatomy in 1910. Neither the 1910 illustration nor any subsequent version was drawn from an anatomical dissection, but rather from the work of John Hunter and Astley Cooper, who described knee anastomosis many years after ligation of the femoral artery for a popliteal aneurysm. [11] Knee anastomosis has not been demonstrated even with modern imaging techniques such as X-ray computed tomography or angiography.[11]

How dangerous is a gap?

Many patients, unaware of the presence of an aneurysm, continue to lead a normal lifestyle. The formation and growth of this formation can last more than 3 years, accompanied by minor symptoms. Under the influence of physical overload, during pregnancy or childbirth, with a sharp increase in pressure, a rupture of the wall of the femoral artery can occur. If the patient is not operated on in a timely manner, intense bleeding is life-threatening.

In addition to rupture, the presence of an aneurysm increases the risk of the following complications:

• blockage of an artery by a blood clot;
• movement of parts of a blood clot with embolism of the branches and gangrene of the lower extremities;
• suppuration of a hematoma (false aneurysm) with phlegmon of surrounding tissues;
• trophic disorders (dermatitis, ulcers) due to lack of blood flow.

Links[edit]

1. Schulte, Eric; Schumacher, Udo (2006). "Arterial blood supply of the thigh". In Ross, Lawrence M.; Lamperti, Edward D. (ed.). Thieme's Atlas of Anatomy: General Anatomy and the Musculoskeletal System
   . Time. p. 490. ISBN 978-3-13-142081-7.
2. Jacob, S. (1 January 2008), Jacob S. (ed.), "Chapter 6 - Lower Limbs", Human Anatomy
   , Churchill Livingstone, pp. 135-179,. Doi: 10.1016/b978-0-443-10373-5.50009-9, ISBN 978-0-443-10373-5, retrieved January 18, 2021
3. ^ a b Mikael Häggström (2019). "Subsartorial vessels as a substitute name for the superficial femoral vessels" (PDF). International Journal of Anatomy, Radiology and Surgery
   : AV01 – AV02.
4. Snell, Richard S. (2008). Clinical anatomy by region (8th ed.). Baltimore: Lippincott Williams and Wilkins. pp. 581–582. ISBN 978-0-7817-6404-9.
5. Bundens, W.P.; Bergan, JJ; Halasz, N. A.; Murray, J; Drehobl, M. (1995). “Superficial femoral vein. Misnomer, potentially life-threatening." JAMA
   .
   274
   (16):1296–8. DOI: 10.1001/jama.1995.03530160048032. PMID 7563535.
6. Hammond, I (2003). "Superficial femoral vein." Radiology
   .
   229
   (2): 604, discussion 604-6. DOI: 10.1148/radiol.2292030418. PMID 14595157.
7. Kitchens CS (2011). "How to treat superficial vein thrombosis". Blood
   .
   117
   (1):39–44. DOI: 10.1182/blood-2010-05-286690. PMID 20980677.
8. Thiagarajah R, Venkatanarasimha N, S Freeman (2011). "Use of the term 'superficial femoral vein' in ultrasound." J Clin Ultrasound
   .
   39
   (1): 32–34. DOI: 10.1002/jcu.20747. PMID 20957733. S2CID 23215861.
9. Deakin, Charles D.; Low, J. Lorraine (September 2000). "Accuracy of advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: an observational study". BMJ
   .
   321
   (7262):673–4. DOI: 10.1136/bmj.321.7262.673. PMC 27481. PMID 10987771.
10. McPherson, D.S.; Evans, D.H.; Bell, P.R.F. (January 1984). "Doppler waveforms of the common femoral artery: comparison of three objective analysis methods with direct pressure measurements." British Journal of Surgery
    .
    71
    (1):46–9. DOI: 10.1002/bjs.1800710114. PMID 6689970. S2CID 30352039.
11. ^ abc Sabalbal, M.; Johnson, M.; McAllister, W. (September 2013). "Absence of knee arterial anastomosis, as is usually indicated in textbooks". Annals of the Royal College of Surgeons of England
    .
    95
    (6):405–9. DOI: 10.1308/003588413X13629960046831. PMC 4188287. PMID 24025288.

Additional images[edit]

• Structures passing behind the inguinal ligament. (The femoral artery is indicated at the top right.)
• Transverse section showing the structures surrounding the right hip joint.
• The shell of the femur is opened to show its three compartments.
• Femoral artery.
• The spermatic cord in the inguinal canal.
• Anterior part of the right thigh with markings on the surface of the bones, femoral artery and femoral nerve.
• Femoral artery and its main branches - right thigh, anterior view.
• Illustration showing the main arteries of the leg (front view).
• Femoral artery - deep dissection.
• Femoral artery - deep dissection.