Femoral artery and its branches

Hello everyone! This is Megan from Kenhub, and welcome to our tutorial on the femoral artery and its branches. The femoral artery is the major blood supply to the lower limb. It supplies most of the thigh as well as the entirety of the leg and foot. During this tutorial, we'll go over the anatomical course of the femoral artery and talk about its branches. To finish up, we'll go over a few clinical points about the femoral artery which are helpful to know in clinical practice.

So in this illustration, we can see the femoral artery highlighted in green with the surrounding soft tissues removed. We can also see the transition from the external iliac artery to the femoral artery as it passes underneath the inguinal ligament which is this structure here. So the first thing you need to know about the femoral artery is that it is a continuation of the external iliac artery.

As you can see in this image, the aorta bifurcates into two common iliac arteries. Each common iliac artery then bifurcates into the external iliac artery and the internal iliac artery. Two notable branches of the external iliac artery are located in this region here. So now let's discuss them in more detail.

The vessel highlighted in this image just before the external iliac artery passes under the inguinal ligament become the femoral artery is the inferior epigastric artery. This vessel always arises just before the external iliac artery reaches the inguinal ligament. It passes up via the transversalis fascia and then pierces the rectus abdominis muscle.

Now let's see another artery which arises nearly at the same level as the inferior epigastric artery but on the opposite side. This is the deep circumflex iliac artery which as you can see arises from the lateral aspect of the external iliac artery. I must mention that this image is slightly misleading as it appears that the deep circumflex iliac artery originates after the inguinal ligament as a branch of the femoral artery, however, this is not the case. This artery is a branch of the external iliac artery and arises at the level of the inguinal ligament where the external iliac artery becomes the femoral artery. It ascends obliquely and laterally posterior to the inguinal ligament and then it travels to the anterior superior iliac spine where it anastomosis with the ascending branch of the lateral femoral circumflex artery.

Okay, so we've successfully established that the femoral artery is a continuation of the external iliac artery. But where does the femoral artery begin? The ligament highlighted here in green is known as the inguinal ligament. You can see in this image that the external iliac artery passes beneath this ligament. It passes under the inguinal ligament about halfway between the anterior superior iliac spine which is an important bony landmark of the hip bone and the pubic symphysis which is a joint that unites the two pubic bones of the hip.

The femoral artery said to begin at this point where the external iliac artery passes under the inguinal ligament. So in this illustration, we can see the inguinal ligament here running between the anterior superior iliac spine and the pubic symphysis here. About halfway, we can see the external iliac artery passing underneath this structure to become the femoral artery. So now let's have a look at the femoral artery.

The femoral artery after passing below the inguinal ligament travels down the anteromedial aspect of the thigh giving off many muscular branches before it enters the adductor canal to become the popliteal artery. Here, it's worth mentioning that the adductor canal can also be referred to as the adductor hiatus. These terms are synonymous with each other which means that they refer to the same structure. So first we'll discuss the course of the femoral artery through the regions of the thigh and then we'll talk about the vessels that branch off the femoral artery before the origin of another major vessel which is the deep femoral artery. Finally, we'll discuss the courses and branches of the deep femoral artery.

The femoral artery enters the thigh in a region known as the femoral triangle. The femoral triangle is a wedge-shaped depression found inferior to the inguinal ligament. As we can see in this image, this triangle is bounded by the inguinal ligament superiorly, the adductor longus medially and the sartorius muscle laterally. The fascia lata has been removed in this image but normally it forms the roof of the femoral triangle.

Another thing to note is that within the femoral triangle, the femoral artery is enclosed in a sheath with the femoral vein. This sheath is known as the femoral sheath but it does not contain the femoral nerve, only the femoral artery and vein. A useful way to remember the contents of the femoral triangle is the acronym VAN. So from medial to lateral, we have the femoral vein for V, the femoral artery for A, and the femoral nerve for N. We can also see some inguinal lymph nodes in this triangle.

So to help you organize and remember the borders of the femoral triangle a bit more easily, I'm just going to go through them systematically in this one slide. So the superior border is the inguinal ligament, the medial border is the muscle adductor longus, and the lateral border is the sartorius muscle. And just as a reminder, the femoral sheath is a connective tissue sheath that contains the femoral artery and vein.

So let's quickly summarize the anatomical course of the femoral artery. It begins as it passes under the inguinal ligament halfway between the anterior superior iliac spine and the pubic symphysis. It then passes through the femoral triangle before passing down the anteromedial aspect of the thigh superficial to the adductor magnus and longus muscles. It then passes through the adductor hiatus where it ends and becomes the popliteal artery. In this illustration, we can see the femoral artery passing through the adductor hiatus to become the popliteal artery. So now we're ready to discuss the branches of the femoral artery.

The first branch we'll talk about is the superficial epigastric artery. The superficial epigastric artery is highlighted in this image in green and as you can see, it arises about 1 centimeter below the inguinal ligament. It travels through the cribriform fascia and descends towards the abdominal superficial fascia. The cribriform fascia is a region of the superficial fascia of the thigh that's perforated. The name cribriform is derived from the Latin word cribrum which means "sieve". This artery supplies the skin of the inguinal region, superficial fascia and superficial inguinal lymph nodes.

The next branch we'll talk about is the superficial circumflex iliac artery, which is the smallest branch of the femoral artery. It arises almost at the level of the superficial epigastric artery, which is the branch that we just talked about. The superficial circumflex iliac artery passes through the fascia lata before coursing towards the anterior superior iliac spine. Like the superficial epigastric artery, it supplies the skin, the superficial fascia and the superficial inguinal lymph nodes.

Now let's move on to the next branch of the femoral artery. This artery is known as the superficial external pudendal artery. It arises slightly below the first two branches – the superficial epigastric artery and the superficial circumflex iliac artery. It travels through the cribriform fascia before crossing the spermatic cord deep to the long saphenous vein. This artery supplies the lower abdominal skin as well as the penile, scrotal or labial skin.

Another branch the femoral artery gives off in the proximal thigh is the deep external pudendal artery. As you can see, this artery arises slightly below the superficial external pudendal artery. Like the name suggests, this artery is found more deep to the superficial external pudendal artery. This artery is covered by fascia lata and passes medially over the pectineus and adductor longus muscles. Following this, it pierces the fascia lata to supply the skin of the scrotum or labia major as well as the skin of the perineum.

We will now discuss the largest branch of the femoral artery which is the deep femoral artery. This artery is also known as profunda femoris or the deep artery of the thigh. As we can see in this image, the deep femoral artery arises laterally from the femoral artery approximately 3.5 cm below the inguinal ligament. It then continues down the lateral aspect of the thigh before it pierces the adductor magnus to anastomose with the muscular branches of the popliteal artery. The deep femoral artery is the main blood supply to the muscles that extend, flex and adduct the thigh and is therefore referred to as a muscular branch of the femoral artery. The deep femoral artery itself gives off many branches including the lateral circumflex femoral artery, the medial circumflex femoral artery and the perforating arteries.

Let's have a look at the most important of these arteries – the lateral circumflex femoral artery. As we can see in this image, the lateral circumflex femoral artery arises from the lateral aspect of the deep femoral artery. It runs deep to the sartorius and rectus femoris muscles and divides into ascending, descending and transverse branches. We'll now have a look at these branches in more detail.

Here we can see the ascending branch of the lateral circumflex femoral artery. This branch ascends along the intertrochanteric line of the femur and supplies the greater trochanter which is this bony landmark here. The transverse branch arises laterally and travels superficial to the vastus intermedius muscle. It then pierces the vastus lateralis before it anastomoses with the smaller arterial branches of the lateral surface of the thigh.

The final branch of the lateral circumflex femoral artery or the descending branch descends deep to the rectus femoris and along the anterior border of the vastus lateralis. It supplies the vastus lateralis muscle. The deep femoral artery also gives off some perforating arteries. They're called the perforating arteries because they perforate the adductor magnus muscle. This artery highlighted in green is the first perforating artery and it supplies the adductor brevis, the adductor magnus, biceps femoris, and gluteus maximus. In the next image, we can see the second perforating artery which is longer than the first and supplies the muscles on the posterior aspect of the thigh. It usually divides into ascending and descending branches.

The final branch of the femoral artery we'll talk about is the descending genicular artery. This artery is the most distal branch of the femoral artery and arises just proximal to the adductor hiatus. As a reminder, the adductor hiatus is a canal within the adductor magnus muscle which we can see here. The descending genicular artery descends within the vastus medialis muscle, which has been removed in this illustration to show the artery here. This artery and its branches supply the vastus medialis and adductor magnus muscles as well as the proximomedial skin of the thigh.

Finally to end this tutorial, we will discuss some clinical notes on the femoral artery that are relevant to clinical practice. The femoral artery can be palpated in order to feel the femoral pulse. The best place to palpate the pulse is midway between the anterior superior iliac spine and the pubic symphysis just inferior to the inguinal ligament. If the pulse is diminished, this may indicate partial occlusion or blockage of the common iliac artery or the external iliac artery. It may also indicate aortic coarctation, which is a congenital condition that causes narrowing of a segment of the aorta.

Another thing that's important to note is that the femoral artery is a common site for cannulation as it provides access to the heart as well as various other vessels. Cannulation is a procedure carried out in medical practice where a small tube known as a cannula is inserted into a vessel. Coronary artery angioplasty is a common intervention used in coronary artery disease which involves cannulation of the femoral artery. After successful femoral artery cannulation, a catheter is inserted into the femoral artery and passed through the various arteries such as the common iliac artery and aorta before it reaches the coronary artery. A wire and a balloon are then used to dilate the coronary artery.

The final clinical points we'll talk about are femoral artery laceration and femoral artery occlusion. Due to its superficial position within the femoral triangle, the femoral artery is vulnerable to laceration. In anterior thigh wounds, the femoral vein is also commonly lacerated due to its close proximity with the femoral artery. Femoral artery occlusion can be caused by atherosclerosis, which you can see in peripheral vascular disease. Atherosclerosis refers to when arteries become clogged up by fatty substances. Occlusion of the femoral artery can cause intermittent claudication of the calf. This is a cramp-like pain of the calf exacerbated by movement and relieved by rest.

And that concludes our tutorial on the femoral artery and its branches. I hope you enjoyed it and thank you for listening.

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