Vessels of the lower limb

Sami Z. , MD
A.Gluteal vessels
1- superior gluteal vessels

Superior gluteal artery is a branch of the posterior

division of of the internal iliac artery .

Leaves the pelvis through greater sciatic foramen above

the pirifomis muscle.

Divides into superficial and deep

Gluteal vessels cont..
The superficial division supplies the gluteus maximus

The deep division supplies the gluteus medius and

minimus.

The upper branch of the deep division extends to ASIS

to anastomose with ascending branch of lateral
circumflex femoral artery and deep circumflex iliac
artery.
Gluteal vessels cont..
The lower branch anastomose with the inferior gluteal
artery in the region of trochantric fossa where they are
joined by asending branch of medial circumflex artery.

This anastomosis is called the trochntric anastomosis.

In addition to adjacent muscles, the superior gluteal

artery contributes to the supply of the hip joint
Gluteal vessels cont..
2-Inferior gluteal artery
The inferior gluteal artery originates from the anterior
trunk of the internal iliac artery in the pelvic cavity

It leaves the pelvic cavity with the inferior gluteal nerve
through the greater sciatic foramen inferior to the
piriformis muscle
Gluteal vessels cont..
The inferior gluteal artery supplies adjacent muscles

 descends through the gluteal region and into the

posterior thigh where it supplies adjacent structures
and anastomoses with perforating branches of the
femoral artery.

 It also supplies a branch to the sciatic nerve.

One branch of inferior gluteal artery shares in the
cruciate anastomosis.
Cruciate anastomosis
Occurs between four arteries in the upper most part of
the back of the thigh
Resembles the cross
Medial horizontal limb is branch of medial circumflex
femoral artery
Lateral horizontal limb is branch of lateral circumflex
femoral artery
The upper sagital limb is branches of supperior and
inferior gluteal aretries
The lower limb is branch of profunda femoris artery
The cruciate anastomosis forms a connection
between the internal iliac artery and the femoral artery
Veins supply
Inferior and superior gluteal veins follow the inferior
and superior gluteal arteries into the pelvis where they
join the pelvic plexus of veins.

 Peripherally, the veins anastomose with superficial

gluteal veins, which ultimately drain anteriorly into
the femoral vein.
B. Internal pudendal vessels
The internal pudendal artery is a branch of anterior
division of the internal iliac artery

Leaves the pelvis through the great sciatic formen

below the piriformis .
c.Obturator vessels
The obturator artery originates as a branch of the
internal iliac artery in the pelvic cavity and enters the
medial compartment of thigh through the obturator
canal

As it passes through the canal, it bifurcates into an

anterior branch and a posterior branch, which
together form a channel that circles the margin of the
obturator membrane and lies within the attachment of
the obturator externus muscle.
Vessels arising from the anterior and posterior
branches supply adjacent muscles and anastomose
with the inferior gluteal and medial circumflex
femoral arteries.
Femoral artery
The femoral artery is the continuation of the external
iliac artery .

Provides main aretrial supply to The lower limb.

begins as the external iliac artery passes under the

inguinal ligament to enter the femoral triangle on the
anterior aspect of the upper thigh
The femoral artery is palpable in the femoral triangle
just inferior to the inguinal ligament midway between
the anterior superior iliac spine and the pubic
symphysis

The femoral artery passes vertically through the

femoral triangle and then continues down the thigh in
the adductor canal
It leaves the canal by passing through the adductor
hiatus in the adductor magnus muscle and becomes
the popliteal artery behind the knee.
Branches of femoral artery
1- deep external pudendal artery

Arise about one and half inch below the ingiunal

ligament

Passes medialy behind the spermatic cord or round

ligament of the uterus to supply the external genital
organs
Branches of femoral artery
2-A cluster of four small branches-
superficial epigastric artery,
superficial circumflex iliac artery,
superficial external pudendal artery, and
Deep external pudendal artery-
originate from the femoral artery in the femoral
triangle and
 supply cutaneous regions of the upper thigh, lower
abdomen, and perineum
Branches of femoral artery
3- profunda femoris artery

is the largest branch of the femoral artery and the chief
artery to the thigh.

It arises from the femoral artery in the femoral triangle in

the middle third of the thigh,

it is separated from the femoral artery and vein by the

adductor longus
Branches of the deep artery of thigh( profunda
femoris) are

 lateral circumflex

medial circumflex femoral and

 perforating branches
The medial circumflex femoral artery is clinically
important because it supplies most the blood to the
head and neck of the femur.

The lateral circumflex femoral artery gives branches

that supply the muscles on the lateral side of the thigh
and head of femur.
The perforating artery are four in number
First- cruciate anastomosis
Second- nutrient artery to the femur
Third-
Fourth– anastomoses with branches of popliteal artery
The popliteal artery
It is a continuation of the femoral artery at the
opening in the adductor magnus.

It is the deepest of the contents of the popliteal fossa

At the distal border of the popliteus ,the popiliteal

artery ends by dividing into anterior and posterior
tibial artery.
Branches of popliteal artery
1- muscular branches

2- cutaneous branches

3- articular branches

1- muscular branches
Supply hamstring muscles
Muscles of the calf

2- cutaneous branches

Supply the skin
3- articula branches
Five branches suppling the knee joint
Share in the anastomosis around the knee joint
Anterior tibial artery
One of the two terminal branch of popliteal artery

Originate at the distal border of the popliteus in the

posterior compartment of the leg.

passes forward into the anterior compartment of leg

through an aperture in the interosseous membrane.
It leaves the leg by passing anterior to the distal end of
the tibia and ankle joint and continues onto the dorsal
aspect of the foot as the dorsalis pedis artery

In the proximal leg, the anterior tibial artery has a

recurrent branch, which connects with the
anastomotic network of vessels around the knee joint
the anterior tibial artery supplies numerous branches
to adjacent muscles and is joined by the perforating
branch of the fibular artery, which passes forward
through the lower aspect of the interosseous
membrane from the posterior compartment of leg.
Distally, the anterior tibial artery gives rise to an

anterior medial malleolar artery and

an anterior lateral malleolar artery

Posterior tibial artery
Origin at the distal border of the popliteus
Branches
1- circumflex fibular artery
2-peroneal artery
3-medial malleolar branch
4-calcanean branch
Peroneal artery
Largest branch of posterior tibial artery
Branches –to soleus
Flexor hallucis longus
Tibialis posterior
Peroneal muscles etc

The terminal branch of posterior tibial artery are the

medial and lateral plantar arteries
Dorsal venous arch

Network of veins on the dorsum of the foot

Lies in the superficial fascia of the distal part of

dorsum of the foot

The medial end of the arch unite with the medial

dorsal digital vein of the big toe to form the great
saphenous vein.
The lateral end of the arch unites with the lateral
dorsal digital vein of the little toe to form the samll
saphenous vein
The great saphenous vein
Begins at the medial end of the dorsal veins arch

Ascends infront of the medial malleolus

Ascends along the medial side of the leg and knee

after crossing the medial surface of the tibia obliquely

In the thigh it ascendes upward and lateral to reach

the saphenous opening…..ends in the femoral vein
Popliteal vein
Formed at the distal border of the popliteus by the
union of the venae comitantes of the anterior and
posterior tibial arteries

Receives tributary from the small saphenous vein

The small saphenous vein
Arise from the lateral end of the dorsal venous arch of
the foot
Runs backwards along the lateral border of the foot

Ascends upwards in te superficial fascia of the back of

the leg.

Ends in the popliteal vein

The femoral vein
Continuation of the popliteal vein
Tributaries of the femoral vein are
Muscular vein
Deep external pudendal vein
Profunda femoris vein
Medial circumflex femoral vein
Lateral circumflex femoral vein
Great saphenous vein
The femoral vein cont…
It ascends behind the ingiunal ligament where it
continues as external iliac vein.
Lymphatic Drainage of the Lower Limb
The lower limb has superficial and deep lymphatic
vessels

The superficial lymphatic vessels converge on and

accompany the saphenous veins and their tributaries

The lymphatic vessels accompanying the great

saphenous vein end in the vertical group of superficial
inguinal lymph nodes.
The deep lymphatic vessels from the leg accompany
deep veins and enter the popliteal lymph nodes.

Most lymph from these nodes ascends through deep

lymphatic vessels to the deep inguinal lymph nodes

Lymph from the deep nodes passes to the external and

common iliac lymph nodes and is then received by the
lumbar lymphatic trunks