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called the external iliac artery, in the proximal two-thirds of the thigh it receives. the name of the femoral artery, whilst its distal part, which is situated on the flexor aspect of the knee, is termed the popliteal artery.
FIG. 776.-THE ARTERIES OF THE BUTTOCK AND THE POSTERIOR ASPECT OF THE THIGH AND KNEE. NOTE. In the specimen there was no anastomotic branch of the inferior gluteal artery, and the transverse terminal branch of the medial femoral circumflex artery pierced the upper part of the adductor magnus.
ARTERIA ILIACA EXTERNA.
The external iliac artery (Figs. 777, 778) extends from a point opposite the sacro-iliac joint, at the level of the lumbo-sacral articulation, to a point below the
inguinal ligament (Poupart's), midway between the anterior superior spine of the ilium and the symphysis pubis, where it becomes the femoral artery. Its length is about 87 to 100 mm. (three and a half to four inches), and in the adult it is usually somewhat larger than the hypogastric artery.
It runs downwards, forwards, and laterally, along the superior aperture of the pelvis minor, resting upon the fascia iliaca, which separates it, above, from the medial border, and, below, from the anterior surface of the psoas major muscle; and it is enclosed, with its accompanying vein, in a thin fascial sheath.
Relations. Anterior.-It is covered in front by peritoneum, which separates it on the left side from the iliac colon, and coils of small intestine, and on the right side from the terminal portion of the ileum, and sometimes from the vermiform process. The ureter, descending behind the peritoneum, sometimes crosses the front of the artery near its origin, and in the female the ovarian vessels cross the upper part of the artery. Near its lower end the artery is crossed anteriorly by the external spermatic branch of the genito-femoral nerve and by the deep circumflex iliac vein. In the male this part of the artery is crossed also by the ductus deferens, and in the female by the round ligament of the uterus. Several iliac lymph glands lie in front and at the sides of the external iliac artery, and almost invariably one of these is directly anterior to its termination.
Posterior. The fascia iliaca and psoas major muscle lie behind the artery. Near its upper end the obturator nerve and the external iliac vein are posterior to the vessel. Lateral. On its lateral side is the genito-femoral nerve. Medial.-To the medial side of its lower part is the external iliac vein.
Branches. In addition to small branches to the psoas major muscle and to the lymph glands, two named branches of considerable size spring from the external iliac artery, viz., the inferior epigastric and the deep circumflex iliac.
(1) Arteria Epigastrica Inferior. The inferior epigastric artery (Figs. 774 and 777) arises, immediately above the inguinal ligament, from the front of the external iliac. It lies in the extra-peritoneal fat, it curves forwards from its origin, turns round the lower border of the peritoneal sac, and runs upwards and medially, along the medial side of the abdominal inguinal ring and along the lateral border of the medial inguinal fossa; it then pierces the transversalis fascia, passes over the semicircular fold (Douglas) and enters the sheath of the rectus abdominis muscle. For a short distance it ascends posterior to the rectus, but it soon penetrates the substance of the muscle, and breaks up into branches which anastomose with terminal offsets of the superior epigastric branch of the internal mammary artery and with the lower intercostal arteries. At the abdominal inguinal ring, in the male, the ductus deferens, the testicular vessels, and the external spermatic branch of the genitofemoral nerve hook round the front and lateral side of the artery, the ductus deferens turning medially behind it; whilst in the female the round ligament of the uterus and the external spermatic branch of the genito-femoral nerve occupy the corresponding positions.
Branches. (a) Muscular branches supply the rectus, the pyramidalis, the trans versus, and the oblique muscles of the abdominal wall, and anastomose with branches of the deep circumflex iliac, the lumbar, and the lower intercostal arteries. (b) Cutaneous branches, which pass from the front of the inferior epigastric, pierce the rectus abdomins and the anterior part of its sheath, and terminate in the subcutaneous tissues of the anterior abdominal wall, where they anastomose with corresponding branches of the opposite side and with branches of the superficial epigastric artery. (c) The external spermatic in the male (artery of the round ligament of the uterus in the female) is small. It descends through the inguinal canal and anastomoses with the external pudendal and the scrotal branches of the perineal artery, and in the male with the internal spermatic artery also. In the male it accompanies the spermatic funiculus supplying its coverings, including the cremaster. In the female it runs with the round ligament. (d) The pubic branch descends, either on the lateral or the medial side of the femoral ring, to anastomose with the pubic branch of the obturator artery; it anastomoses also with its fellow of the opposite side. Sometimes, when the obturator branch of the hypogastric artery is absent, the pubic branch of the inferior epigastric artery enlarges and becomes the obturator artery, which descends to the obturator foramen either on
the lateral or the medial side of the femoral ring. In the latter case the artery may be injured in the operation for the relief of a strangulated femoral hernia.
(2) Arteria Circumflexa Ilium Profunda.-The deep circumflex iliac artery (Figs. 774 and 777) springs from the lateral side of the external iliac artery, usually a little below the inferior epigastric, and immediately above the inguinal ligament. It runs laterally and upwards to the anterior superior spine of the ilium. In that part of its course it lies just above the lower border of the inguinal ligament, and is enclosed in a fibrous canal formed by the union of the transversalis and iliac fasciæ. A little beyond the anterior superior spine it pierces the transversus
FIG. 777. THE ILIAC AND HYPOGASTRIC ARTERIES AND VEINS IN THE FEMALE.
abdominis, and is continued between the transversus and the internal oblique, to terminate by anastomosing with branches of the ilio-lumbar artery.
Branches. (a) Muscular to the upper parts of the sartorius and the tensor fasciæ latæ, and to the muscles of the abdominal wall. One of the latter branches is frequently of considerable size; it pierces the transversus muscle a short distance anterior to the anterior superior spine of the ilium, and ascends vertically, between the transversus and the internal oblique, anastomosing with the lumbar and the epigastric arteries. (b) Cutaneous branches pierce the muscles. They terminate in the skin over the crest of the ilium, and they anastomose with the superior gluteal, the superficial circumflex iliac, and the ilio-lumbar arteries.
The femoral artery (Figs. 778 and 779) is the continuation of the external iliac into the thigh. It commences at the lower border of the inguinal ligament
(O.T. Poupart's), passes through the proximal two-thirds of the thigh, and terminates at the opening in the adductor magnus. At one time it was customary to speak of the first one and a half inches, as far as the origin of the profunda
A. et V., circumflexa ilium profunda"
M. rectus femoris Nerve to pectineus Nerve to rectus femoris
M. tensor fascia lata
A. circumflexa femoris lateralis (ramus ascendens)
Nerve to vastus lateralis A. circumflexa femoris lateralis (ramus transversus) Medial cutaneous nerve of thigh N. saphenus
Nerve to vastus medialis
Nerve to vastus lateralis
A. circumflexa femoris lateralis
M. vastus medialis
Nerve to vastus medialis
Rami superficiales (epigastrica, circumflexa ilium, pudenda externa)
Nerve to adductor longus
FIG. 778.-THE FEMORAL ARTERY AND ITS BRANCHES.
NOTE.-The outlines of the sartorius, the upper part of the rectus femoris, and the adductor longus are indicated by broken black lines.
branch, as the common femoral, and to say that it divided into the superficial and deep femoral branches, of which the former was the direct continuation of the common trunk. The morphology and development of the vessel gives no support for such terminology.
THE FEMORAL ARTERY.
Course. Its general direction is indicated by a line drawn from the point of origin, midway between the anterior superior spine of the ilium and the symphysis pubis, to the adductor tubercle, the thigh being flexed, abducted, and rotated laterally.
In its proximal half the femoral artery lies in the femoral trigone (O.T. Scarpa's triangle), and is comparatively superficial; at the apex of the trigone it passes deep to the sartorius, enters the adductor canal (Hunter's), and is thus more deeply placed.
At their entry into the femoral trigone both the artery and its vein are enclosed, for a distance of 31 mm. (one and a quarter inches), in a funnel-shaped fascial sheath formed of the fascia transversalis anteriorly and the fascia iliaca posteriorly. This is called the femoral sheath; it is divided, by antero-posterior septa, into three compartments, of which the lateral is occupied by the femoral artery and lumbo-inguinal branch of the genito-femoral nerve; the intermediate compartment contains the femoral vein; and the medial compartment constitutes the femoral canal.
Relations. Anterior.-In the femoral trigone the femoral artery is covered superficially by skin and fasciæ, by superficial sub-inguinal lymph glands and small superficial vessels. The anterior part of the femoral sheath and the fascia cribrosa are in front of the proximal part of the artery, and the fascia lata is in front of the distal part. Near Posterior. It is in relation, the apex of the triangle the artery is crossed by the medial cutaneous nerve, and not infrequently by a tributary of the great saphenous vein. posteriorly, proximo-distally, with the posterior part of the femoral sheath, the pubic or pectineal portion of the fascia lata and the psoas major, the pectineus, and the proximal The nerve to the pectineus passes between the part of the adductor longus muscles. artery and the psoas major; the femoral vein and the profunda artery and vein intervene between it and the pectineus, and the femoral vein also separates it from the adductor longus.
The femoral vein, which lies on a plane posterior to the artery in the lower part of the femoral trigone, passes to its medial side above, where it is separated from the artery by the lateral septum of the femoral sheath. On the lateral side of the artery is the The lumbo-inguinal femoral nerve (O.T. anterior crural) proximally; more distally the saphenous nerve and the nerve to the vastus medialis are continued on the lateral side. branch of the genito-femoral nerve is anterior and to the lateral side, proximally, as it runs for a short distance in the femoral sheath.
The In the adductor canal the artery has posterior to it the adductor longus and the adductor magnus, whilst anterior and to the lateral side is the vastus medialis. femoral vein is also posterior to the artery, but lies to its lateral side distally and to The saphenous its medial side proximally. Anterior to the artery is the fascial roof of the canal, with the obturator or sub-sartorial plexus of nerves and the sartorius muscle. nerve enters the adductor canal with the artery, and runs first on its lateral side, then anterior, and lastly on its medial side.
Branches. The femoral artery gives off the following branches :-
(a) The superficial circumflex iliac.
(b) The superficial epigastric.
(c) The superficial external pudendal. (2) Muscular.
(3) The deep external pudendal.
(4) The profunda.
(5) The arteria genu suprema.
(a) Arteria Circumflexa Ilium Superficialis.-The superficial circumflex iliac springs from the front of the femoral artery, just below the inguinal ligament. It pierces the femoral sheath and the fascia lata, lateral to the fossa ovalis (O.T. saphenous opening), and runs, in the superficial fascia, as far as the anterior superior spine of the ilium. It supplies the lateral set of sub-inguinal glands and the skin of the groin, and it sends branches, through the fascia lata, which anastomose with branches of the deep circumflex iliac artery, and supply the upper parts of the sartorius and tensor fascia latæ muscles.
(b) Arteria Epigastrica Superficialis.-The superficial epigastric artery arises near the preceding. It pierces the femoral sheath and the fascia cribrosa,