The femoral artery is a continuation of the external iliac artery and constitutes the major blood supply to the lower limb. In the thigh, the femoral artery passes through the femoral triangle, a wedge-shaped depression formed by muscles in the upper thigh. The medial and lateral boundaries of this triangle are formed by the medial margin of adductor longus and the medial margin of sartorius, respectively. Fascia lata constitutes the roof of the femoral triangle whilst the floor is formed by pectineus and adductor longus medially as well as by iliacus and psoas major laterally. Within this triangle, the femoral artery is enclosed in a femoral sheath with the femoral vein. The femoral artery and its branches supply most of the thigh as well as the entirety of the leg and foot.
This article will discuss the anatomical course, relations and variations of the femoral artery as well as briefly talking about its branches. This will be followed by a discussion of the clinical relevance of the femoral artery.
Midway between the anterior superior iliac spine and the pubic symphysis, the external iliac artery passes under the inguinal ligament into the femoral triangle and becomes the femoral artery. The artery then travels down the anteromedial aspect of the thigh before it passes through the adductor, or subsartorial, canal. When the femoral artery passes through the adductor hiatus it becomes the popliteal artery.
Relationships of the femoral artery to other structures within the thigh can be important in clinical practice. Within the femoral triangle, the femoral artery is located deep to the skin, superficial fascia, superficial inguinal lymph nodes, fascia lata, superficial circumflex iliac vein and the femoral branch of the genitofemoral nerve.
At the apex of the femoral triangle, the medial femoral cutaneous nerve crosses the artery in a lateral to medial direction. The tendons of psoas major, pectineus and adductor longus pass deep to the femoral artery within the triangle. Proximally, the femoral vein is medial to the femoral artery within the sheath. At the apex of the triangle, the vein is found deep to the artery.
Within the adductor canal, the femoral artery is located deep to the skin, superficial fascia, deep fascia and sartorius muscle. The artery is superficial to the adductor magnus and longus muscles. Both the saphenous nerve and femoral vein vary in their location in relation to the femoral artery. The saphenous nerve is initially found lateral to the femoral artery but is also found anterior and then medial to the nerve as it travels through the canal. Proximally, the femoral vein is found deep to the artery but is found lateral to the artery distally. The vastus medialis muscle and its nerve are located anterolateral to the femoral artery.
Distal to the origin of the profunda femoris artery, the femoral artery rarely divides into two trunks, which reunite near the adductor hiatus. Occasionally, the artery is replaced by the inferior gluteal artery, which accompanies the sciatic nerve as it travels towards the popliteal fossa. In this case, the external iliac artery ends as the profunda femoris artery.
The femoral artery gives off five branches in the femoral triangle and one in the adductor canal, to give six in total. These branches are referred to as the:
- Superficial epigastric artery
- Superficial circumflex iliac artery
- Superficial external pudendal artery
- Deep external pudendal artery
- Profunda femoris
- Descending genicular artery
The superficial epigastric artery arises from the femoral artery 1 cm distal to the inguinal ligament. It travels through the cribiform fascia and ascends towards the umbilicus within the abdominal superficial fascia. It supplies the skin, superficial fascia and superficial inguinal lymph nodes.
The superficial circumflex iliac artery, the smallest branch of the femoral artery, arises near the superficial epigastric artery. Lateral to the saphenous opening, the artery passes through the fascia lata before coursing towards the anterior superior iliac spine. Like the superficial epigastric artery, it supplies the skin, superficial fascia and superficial inguinal lymph nodes.
The superficial external pudendal artery arises near the superficial epigastric and superficial circumflex iliac arteries. It travels through the cribiform fascia before crossing the spermatic cord deep to the long saphenous vein. It supplies the lower abdominal skin as well as the penile, scrotal or labial skin.
The deep external pudendal artery crosses the pectineus and adductor longus muscles before traversing the fascia lata. It supplies the skin of the perineum as well as the skin of the scrotum or labium majus.
The profunda femoris, or deep artery of the thigh, is the largest branch of the femoral artery, which arises 3.5 cm distal to the inguinal ligament. The profunda femoris is initially found lateral to the femoral artery before it passes deep to it towards the medial aspect of the femur. It travels between the pectineus and adductor longus muscles before passing between the adductor longus and adductor brevis muscles. It then descends between the adductor longus and adductor magnus muscles before it pierces the adductor magnus to anastamose with the muscular branches of the popliteal artery. The profunda femoris is the main blood supply to the muscles that extend, flex and adduct the thigh.
The most distal branch of the femoral artery is the descending genicular artery, which arises just proximal to the adductor opening within the adductor canal. It descends within the vastus medialis muscle to the medial aspect of the knee. Here, it anastomoses with the medial superior genicular artery. Branches of this artery supply the vastus medialis and adductor magnus muscles as well as the proximomedial skin of the thigh.