Presentation on theme: "Vasculature of the lower limb You don't have to better than everyone else, just better than the day before. Dr Idara."— Presentation transcript:
1 vasculature of the lower limb You don't have to better than everyone else, just better than the day before.Dr Idara
2 Gluteal region Regions of lower limb/ upper margin of lower limb Gateways to lower limbArteries of the gluteal regionArtery of the lower limbAnastomoses btwn gluteal arteries & vessels from the femoral artery in the thighVeins of the lower limb
3 Conceptual overview : pelvic inlet The pelvis is divided into 2 regions:False pelvis (greater pelvis)is the superior region related to the upper parts of the pelvic bones & lower lumbar vertebrae.True pelvis (lesser pelvis)is related to the inferior parts of the pelvic bones, sacrum, & coccyxThe pelvis is divided into the greater (false) and lesser (true) pelvis by an oblique plane of the pelvic inlet (superior pelvic aperture).
4 Conceptual overview: pelvic outlet The diamond-shaped pelvic outlet is formed by both bone & liga- ments.2 ligaments :1. sacrospinous &2. sacrotuberous ligaments are important landmarks.greater sciatic foramenLesser sciatic foramenObturator foramen
5 Conceptual view: muscles of pelvic walls Obturator internus & piriformis muscles arise in the pelvis & exit through the sciatic foramina.Piriformis m.obturator internus m.
6 Communication between the true pelvis, & lower limb 3 apertures in the pelvic wall commu- nicate with the lower limb:The obturator canalThe greater sciatic foramenThe lesser sciatic foramen123
7 Regions of lower limb/ upper margin of lower limb
8 Gateways to lower limbThey are 4 major routes by which structures pass from the abdomen & pelvis into & out of the lower limb.1. Obturator canal2. Greater sciatic foramen3. Lesser sciatic foramen4. Gap between inguinal ligament & pelvic bone.
10 Arteries of the gluteal region 1. Superior gluteal artery (branch of internal iliac a.)2. Inferior gluteal artery (branch of internal iliac a.)3. Obturator artery (branch of internal iliac a.)
11 Arteries of the gluteal region 2 arteries enter the gluteal region from the pelvic cavity through the greater sciatic foramen :1. Inferior gluteal a.2. Superior gluteal a.They have important collateral anastomoses with branches of the femoral artery.21
12 Muscles suppliedSuperior gluteal a. – Gluteus maximus, Gluteus medius and minimus and tensor fascia lataInferior Gluteal a. – Gluteus maximus, obturator internus, Quadratus femoris and part of the HamstringsObturator a. – branch to obturator externus, pectineus, thigh adductors, gracilis.
13 Arteries of the lower limb The major artery supplying the lower limb is the femoral artery.The external iliac artery becomes the femoral artery as it passes under the inguinal ligament to enter the femoral triangle.Femoral a.
15 Branches of the femoral artery 1.Superficial femoral a.2. Deep femoral a.( profunda femoris a.)The deep femoral a. is said to have three branches. They are:Medial circumflex femoral a.Lateral circumflex femoral a.Perforating branches
16 Branches of the deep femoral a. A. The medial circumflex femoral a. is a branch of deep femoral a. & it supplies the head & neck of the femur. It takes part in the cruciate anastomosis.B. The lateral circumflex femoral a. is a branch of the deep femoral a. It is less able to supply the femoral head and neck, it mainly supplies muscles on the lateral side of the thigh. It has three branches.The cruciate anastomoses is found around the knee. Cruciate- cross- shaped.
17 The branches of the lat circumflex femoral a. are: 1. Ascending branch2. Descending branch3. Transverse branchC. perforating arteriesFirst perforating a.Second perforating a.Third perforating a.The fourth perforating a. is the terminal branch of the deep artery itself.
18 Note:Most of the blood supply to the head of femur arises mostly from the medial circumflex femoral artery. Fracture to the neck of the femur can compromise this blood supply leading to avascular necrosis of the neck of femur.
19 Veins(deep) of the lower limb Veins draining the lower limb form superficial & deep groups.The major deep vein draining the lower limb is the femoral vein.It becomes the external iliac vein when it passes under the inguinal ligament to enter the abdomen.Femoral vein
20 The anterior tibial vein originate and receive blood from the dorsalis pedis veins, on the back of the foot and empties into the popliteal vein.The posterior tibial vein also empties into the popliteal vein.The origin of the popliteal vein is defined by the junction of the posterior tibial vein and anterior tibial vein.It becomes the femoral vein when leaving the adductor canal.
21 Femoral veinThe femoral vein begins at the adductor canal as a continuation of the popliteal vein. It ends at the inferior margin of the inguinal ligament, where it becomes the external iliac vein.
22 Veins (superficial) of the lower limb The superficial veins form 2 major channels:Greater saphenous vein.Ascends up the medial side of the leg, knee, thigh to connect with the femoral vein just inferior to the inguinal ligament.Small saphenous vein.Ascends up the posterior surface of the leg, and then join the popliteal vein posterior to the knee; proximal to the knee, the popliteal vein becomes the femoral veinGreater saphenous v.Small saphenous v.
23 Anterior Compartment of the Thigh Muscles: Sartorius, iliacus, psoas, pectineus, and quadriceps femorisBlood supply: Femoral arteryNerve supply: Femoral nerve
24 Medial compartment of thigh Muscles: Gracilis, adductor longus, adductor brevis, adductor magnus, and obturator externus.Blood supply: Profunda femoris artery and obturator artery.Nerve supply: Obturator nerve
25 Posterior compartment of thigh Muscles:Biceps femoris, semitendinosus, semimembranosus, and a small part of the adductor magnus (hamstring muscles)Blood supply: Branches of the profunda femoris arteryNerve supply: Sciatic Nerve
26 Blood Vessels in the Popliteal Fossa Popliteal artery:Continuation of the femoral artery , begins when the latter passes through the adductor hiatus.The popliteal artery is the deepest of the neurovascular structures in the popliteal fossa and is therefore difficult to palpate; however, a pulse can usually be detected by deep palpation medial to the midline.The popliteal artery passes inferolaterally through the fossa and ends at the inferior border of the popliteus by dividing into the anterior and posterior tibial arteries.
27 popliteal arteryIn the popliteal fossa, the popliteal artery gives rise to branches, which supply adjacent muscles, and to a series of geniculate arteries, which contribute to vascular anastomoses around the knee.The genicular arteries are the superior lateral, superior medial, Middle medial and middle lateral, and inferior medial, inferior lateral genicular arteries
28 popliteal veinThe popliteal vein begins at the distal border of the popliteus as a continuation of the posterior tibial vein.The small saphenous vein passes from the posterior aspect of the lateral malleolus to the popliteal fossa, where it pierces the deep popliteal fascia and enters the popliteal vein.
29 The leg Arteries in the posterior compartment of leg Anterior tibial arteryDorsalis pedis arterySuperficial veins of the foot
30 Arteries in the posterior compartment of leg Posterior tibial a. supplies the posterior & lateral compart- ments of the leg & continues into the sole of the foot.Has 2 major branches:Circumflex fibular a.Fibular a.Fibular a.Posterior tibial a.
31 Anterior tibial artery The artery associated with the anterior compartment of leg is anterior tibial a.The anterior tibial a. gives rise toAnterior medial malleolar artery &Anterior lateral malleolar arteryAnt. Tibialis a.
32 Dorsalis pedis artery Is the continuation of the anterior tibial a. As the anterior tibial a. crosses the ankle joint it becomes dorsalis pedis a.Branches are:Lateral tarsalMedial tarsalArcuate a.1rst dorsal metatarsal a.Dorsalis pedis a.
34 Veins There are interconnected networks of Deep & Superficial veins of the foot.The deep veins follow the arteries.Superficial veins drain into a dorsal venous arch on the dorsal surface of the foot over the metatarsals.
35 Superficial veins of the foot Great saphenous vein originates from the medial side of the arch & passes anterior to the medial malleolus & onto the medial side of the leg. It drains into the femoral vein. Small saphenous v. originates from the lateral side of the arch & passes posterior to the lateral malleolus & onto the back of the leg. It drains into the popliteal vein.great saphenous v.small saphenous v..Dorsal venous arch
39 POWER REVIEW1.1.Which arteries represent the primary arterial supply to the thigh?The superficial & deep femoral arteries2.Which branches of the deep femoral artery supply the head & neck of the femur & the muscles on the lateral side of the thigh?The medial & lateral circumflex femoral arteries3.Where does the superficial femoral artery terminate?It becomes the popliteal artery at the adductor hiatus (an opening in the adductor magnus muscle).
40 POWER REVIEW2.4.What are the 2 most important tributaries of the femoral veins?The great saphenous vein & the deep femoral vein5.What is the longest vein in the body?The great saphenous vein6.what fascial landmark denotes the junction of the greater saphenous vein with the femoral vein?The fossa ovalis, an oval-shaped aperture in the fascia lata
41 POWER REVIEW3.7. Name the 5 major tributaries to the great saphenous vein.Superficial circumflex iliac vein; superficial epigastric vein in the thighExternal pudendal vein; lateral femoral cutaneous vein; anterior femoral cutaneous vein8. What is the function of the perforating veins of the lower extremity?They drain the superficial venous system into the deep venous system.Incompetence/dysfuction of these perforating veins contributes to varicose veins of the lower extremities
42 Review1.1. Which of the following structures passes through the saphenous opening?2. The small saphenous vein empties into which of the following veins?3. All of the following statements concerning the femoral triangle are correct EXCEPT4. Which of the following statements concerning the femoral artery is correct?5. Which of the following statements concerning the deep artery of the thigh is correct?
43 Review 2.6.Which of the following arteries supplies most of the blood to the head and neck of the femur?7.All of the following statements concerning the adductor canal are correct EXCEPT8.Which of the following statements concerning the lesser sciatic foramen is correct?9.All of the following structures pass through the greater sciatic foramen EXCEPT
44 Review 3.10. All of the following statements concerning the popliteal fossa are correct EXCEPT11. Which of the following arteries provides the main blood supply for the hip joint?
45 unknownAverage person has 150 teachers in lifetime and only 3 touch that person's life.……………References………………………Clinically Oriented Anatomy , Keith L. Moore, Arthur F. Daley 6th Edition.Images from Google images