1. Blood Supply of the Lower Limb
Dr. Safaa Dr. Sama-ul-Haque

2. Objectives Describe femoral artery and its relations.
Enlist the branches of femoral artery.
Define the trochanteric and cruciate anastomosis.
Describe popliteal artery, its relations and branches.
Discuss the arterial anastomosis around the knee joint.
Discuss the anterior tibial artery, its relations and branches.
Define Dorsalis pedis artery.

3. Objectives
Discuss the posterior tibial artery, its relations and branches.
Explain the formation of dorsal venous arch.
Describe the formation of great saphenous vein and enlist its tributaries.
Discuss the formation of small saphenous vein and enlist its tributaries.
Describe the formation of popliteal vein and femoral veins.

5. Femoral Artery Enters thigh by passing behind inguinal ligament.
Continuation of External iliac artery.
Ends at the opening in the adductor Magnus
muscle and continuous as Popliteal artery.
Relations:
Anteriorly: Skin , Fascia and Sartorius
Posteriorly: Psoas Major
Laterally: Femoral Nerve
Medially: Femoral vein

6. Relations of Femoral Artery

7. Relations of Femoral Artery

8. Femoral Artery Branches: Superficial circumflex iliac artery
Superficial epigastric artery
Superficial external pudendal artery
Deep external pudendal artery
Descending genicular artery

9. Femoral Artery Branches: Profunda femoris artery
Large branch enters the medial compartment
of thigh.
Ends by becoming 4th perforating artery.
Medial femoral circumflex artery
Lateral femoral circumflex artery
1st, 2nd and 3rd perforating arteries.

10. Femoral Artery

11. Femoral
Artery

12. Trochanteric Anastomosis
Anastomosis between the branches of internal iliac
and femoral arteries.
Main supply to the head of Femur.
Branches forming anastomosis:
Superior gluteal artery
Inferior gluteal artery
Medial femoral circumflex artery
Lateral femoral circumflex artery

13. Trochanteric Anastomosis

14. Cruciate Anastomosis
Anastomosis between the branches of internal iliac
and femoral arteries.
Branches forming anastomosis:
Inferior gluteal artery
Medial femoral circumflex artery
Lateral femoral circumflex artery
First Perforating artery
In occlusion of the proximal part of the femoral artery,
blood passes through the cruciate & trochanteric
Anastomosis.

15. Cruciate Anastomosis

16. Popliteal Artery Continuation of Femoral artery.
Ends at the lower border of the Popliteus muscle by dividing into Anterior and Posterior tibial arteries.
Relations:
Anteriorly: Popliteal surface of femur,
Knee joint & Popliteus muscle.
Posteriorly: Popliteal vein & Tibial nerve

17. Popliteal Artery

18. Relations of Popliteal Artery

19. Branches of Popliteal Artery
Muscular branches
Articular branches
Terminal branches
Anterior tibial artery
Posterior tibial artery

20. Anastomosis around Knee joint
Anastomosis between the branches of femoral,
popliteal, anterior and posterior tibial arteries.
Branches forming anastomosis:
Branch of femoral artery
Descending genicular
Articular branches of Popliteal artery
Superior genicular (lateral & medial)
Inferior genicular (lateral & medial)
Small branches of anterior and posterior
tibial arteries

21. Anastomosis around Knee joint

22. Anterior Tibial Artery
Smaller terminal branch of Popliteal artery.
Lies on the anterior surface of interosseous membrane.
In the upper part it lies deep to muscles of anterior compartment.
In the lower part, it becomes superficial at the lower end of the tibia.
Then it lies between the tendons of extensor hallucis longus and extensor digitorum longus.

23. Anterior Tibial Artery

24. Anterior Tibial Artery

25. Anterior Tibial Artery
In front of ankle joint, the artery becomes the Dorsalis pedis artery.
Branches:
Muscular branches to the muscles of anterior compartment
Anastomotic branches
Around Knee and Ankle joints

26. Dorsalis Pedis Artery Also called Dorsal artery of the foot.
Continuation of anterior Tibial artery.
Terminates by joining the lateral plantar artery and completes the plantar arch.
On dorsum of the foot it lies between the tendons
of extensor hallucis longus and extensor digitorum
longus.
Its pulsation can be felt here.

27. Dorsalis Pedis Artery

28. Dorsalis Pedis Artery Branches: Lateral tarsal artery Arcuate artery
Metatarsal branches
First dorsal metatarsal artery

29. Dorsalis Pedis Artery

30. Posterior Tibial Artery
Larger terminal branch of Popliteal artery.
Lies deep to gastrocnemius and soleus muscles.
In the lower part of the leg artery is only covered by skin and fascia.
It passes behind medial malleolus and terminates by dividing into Medial and Lateral Plantar arteries.
Between the medial malleolus and heel, its pulse can be felt.

31. Posterior Tibial Artery

32. Posterior Tibial Artery

33. Posterior Tibial Artery
Branches:
Peroneal or Fibular artery
Larger branch arise close to the origin
Muscular branches
Nutrient artery to the Fibula
Perforating branch

34. Posterior Tibial Artery
Branches:
Muscular branches to muscles of posterior compartment
Nutrient artery to the Tibia
Medial plantar artery
Anastomotic branches
Around Ankle joint

35. Posterior Tibial Artery

36. Posterior Tibial Artery

37. Medial Plantar Artery
Smaller terminal branch of Posterior tibial artery.
Supply medial side of the big toe.
Branches:
Muscular
Cutaneous
Articular

38. Medial Plantar Artery

39. Lateral Plantar Artery
Larger terminal branch of Posterior tibial artery.
On the base of 5th metatarsal bone, it forms Plantar Arch by joining Dorsalis pedis artery.
Branches:
Muscular , Cutaneous and Articular
Branches of Plantar Arch:
Plantar metatarsal arteries
Plantar digital arteries
Three perforating arteries (anastomose with vessels on the dorsal aspect of the foot.

40. Later Plantar Artery and Plantar Arch

41. Areas of Lower Limb Arteries Pulsation

42. Veins of the Lower Limb

43. Veins of the Lower Limb Superficial veins Deep veins
Lie in the superficial fascia
Having Thick muscular wall
Deep veins
Accompany the arteries
Having Thin muscular wall

44. Superficial Veins of the Lower Limb
Dorsal Venous Arch
Great Saphenous Vein
Small Saphenous Vein
Venae Comitantes
Popliteal Vein
Femoral Vein
Deep Veins of the Lower Limb

45. Veins of the Lower Limb

46. Superficial Veins of the Lower Limb

47. Dorsal Venous Arch Lies on the dorsum of the foot.
The blood from the whole foot drains into this arch
via digital veins and communicating veins.
Drains on the medial side into the Great Saphenous vein
Drains on the lateral side into the Small Saphenous vein

48. Dorsal Venous Arch

49. Great Saphenous vein Longest vein in the body.
Drains medial side of the dorsum venous arch.
Passes upward in front of medial malleolus.
Then runs upward in superficial fascia over the medial side of the leg.
Passes behind the knee and curves forward around the medial side of the thigh.

50. Great Saphenous vein It contains 10-20 valves.
Connected to small saphenous vein behind knee.
Perforating veins connect the great saphenous vein with the deep veins.
Passes through saphenous opening.
Finally drains into femoral vein

51. Great Saphenous Vein

52. Great Saphenous Vein

53. Great Saphenous Vein

54. Great Saphenous Vein Tributaries: Subcutaneous tributaries
Superficial circumflex iliac vein
Superficial epigastric vein
Superficial external pudendal vein
Accessory vein

55. Tributaries of Great Saphenous Vein

56. Perforating vein connecting great saphenous vein with a deep vein

57. Small Saphenous vein Drains lateral side of the dorsum venous arch.
Passes upward behind lateral malleolus.
Reaches middle of the back of leg.
Then it pierces deep fascia.
In the lower part of popliteal fossa ends in the popliteal vein.
Contains numerous valves.

58. Small Saphenous Vein Tributaries:
Numerous small veins from the back of the leg.
Communicating veins with deep veins of the foot.
Anastomotic branches that join the great saphenous vein.

59. Small Saphenous Vein

60. Deep Veins of the Lower Limb

61. Venae Comitantes
Deep veins accompany the arteries are called venae comitantes.
The deep plantar venous arch gives medial and lateral
plantar veins.
Medial and lateral plantar veins forms posterior tibial vein behind the medial malleolus.
Peroneal vein drain into posterior tibial vein.
Venae comitantes of anterior and posterior tibial arteries unite in the popliteal fossa to form the popliteal vein.

62. Popliteal Vein
Formed by the venae comitantes of the anterior and posterior tibial arteries.
Ends at the adductor hiatus and continuous upward
as Femoral vein.
Tributaries:
Veins accompany arteries.
Small saphenous vein.

63. Popliteal Vein

64. Femoral Vein Continuation of popliteal vein at adductor hiatus.
Enters in the intermediate compartment of femoral sheath.
Then passes behind inguinal ligament and continuous as External Iliac Vein.

65. Femoral Vein

66. Femoral Vein Tributaries: Great saphenous vein
Tributaries corresponding to the perforating branches of the profunda femoris artery.
Medial and lateral femoral circumflex veins.

67. Femoral Vein

68. Varicose Veins

69. Thank You