Blood Supply

of the Lower Limb

Bakare, A.A
 Aorta
Ascending aorta (Left ventricle)
Arcaorta (has three branches)
Descending aorta

-Thoracic aorta (above

the diaphragm)
- Abdominal aorta
(below the diaphragm)

- Bifurcation
at L4
Bifurcation of abdominal aorta
The abdominal aorta
becomes smaller in
diameter as it descends
giving off branches

And finally the

abdominal aorta
bifurcates into the left
and right common iliac
arteries (L4 Vertebra).
External iliac artery
The external iliac
artery (bigger and
thicker) exits the
pelvic cavity and
passes behind the
inguinal ligament
to enter into the
femoral triangle,
at this point it is
referred to as the
femoral arteries
Femoral Artery

The main artery of the

lower limb.

The femoral aretry

within the femoral
triangle gives off;
 Profunda/deep
femoris and becomes
continuous as the
 Superficial femoris
NB: The part of the femoral
artery proximal to the origin of
profunda femoris is often termed
the common femoral
artery, while that distal to the
origin of the profunda is termed
the superficial femoral artery
External Iliac Artery

Inguinal Ligament

Common Femoral Artery

Profunda Femoris Artery

Superficial Femoral Artery

Profunda femoris
Arises from the posterolateral aspect of
the femoral artery. It gives off three
main branches:
 Medial femoral circumflex artery –
originate from the medial side of the
profunda FA. Wraps round and
supplying the neck and head of the
femur. (easily be damaged during
fracture and avascular necrosis of the
femur head can occur).
 Lateral femoral circumflex artery –
originate from the lateral side of the
profunda FA. Wraps round from the
lateral side of the femur, supplying
some of the muscles in the lateral side
of the thigh.
 Perforating branches –three or four
arteries that perforate the muscles in the
medial and posterior thigh.
Medial Circumflex

Profunda Femoris
Lateral Circumflex

Perforating arteries
Superficial femoral artery in the F

Superficial
femoral artery
descend in the
femoral triangle
heading
towards the
apex of the
triangle to enter
the adductor
canal.
Superficial femoral artery in the
adductor canal
 Moving from the apex of the
femoral triangle, It enters and
passes through the
adductor/subsartorial canal to the
opening in the adductor magnus,
the adductor hiatus.

 The adductor canal is an

aponeurotic/tendinous tunnel in
the middle third of the thigh
formed by the sartorius anteriorly,
adductor longus and adductor
magnus postermedially and
vastus medialis laterally.
Within and existing the adductor hiatus

 Main
branch: descending
geniculate branch arises
from the femoral artery
just before it exit the
adductor hiatus to supply
the geniculate
anastomoses.

 Termination:
continues as the popliteal
artery
Cruciate Anastomosis
 The cruciate anastomosis is a circulatory anastomosis in the
upper thigh.

 Anatomosis between
 Inferior gluteal artery ( internal iliac
artery)
 Lateral and medial circumflex femoral
arteries (profunda femoris artery )
 First perforating artery of the
profunda femoris artery (common
femoris artery)

The cruciate anastomosis is

clinically relevant because
provides an alternative source of
blood supply to the thigh if there is
a blockage between the femoral
artery and external iliac artery.
Popliteal Artery
The popliteal artery is a
continuation of the femoral artery
after it exits the adductor hiatus.

It then goes into the popliteal

fossa posteriorly where it gives
five branches to the genicular
anastomosis
 Medial superior genicular artery
 Lateral superior genicular artery
 Middle genicular artery
 Medial inferior genicular artery
 Lateral inferior genicular artery
Genicular Anastomosis
They participate in the
formation of network of
periarticular anastomosis, a
network of vessels surrounding
the knee that provides
collateral circulation to supply
blood to the leg during full
knee flexion, which may
hooked the popliteal artery
NB: The lateral circumflex
artery also supplies the
anastomosis
Cruciate Anastomosis vs Genicular Anastomosis
More importantly blood can reach
the popliteal artery by means of
the cruciate anastomosis when
there blockage of the femoral
and external iliac artery.

The route of blood then goes

through the internal iliac artery,
to the inferior gluteal artery, to
the cruciate anastomosis then to
the lateral circumflex femoral
artery then to its descending
branch into the superior lateral
genicular artery and thus into
the popliteal artery.
Termination divisions of the popliteal fossa

At the lower
border of Knee
Joint just at
the inferior
border of the
popliteus at
the posterior
knee region

 Anterior
Tibial artery
 Posterior
Anterior Tibial Artery
A smaller terminal
branch of popliteal
artery.

It passes through the

interosseous space
space

Supplies the anterior

compartment of the
leg and dorsal surface
of the foot.
Branches of the anterior tibial artery

1. Posterior tibial recurrent

artery
2. Anterior tibial recurrent
artery
3. Muscular branches
4. Anterior medial malleolar
artery
5. Anterior lateral malleolar
artery

Dorsalis pedis artery

Posterior tibial recurrent artery

The posterior tibial recurrent

artery, is given off from the
anterior tibial artery before the
vessel passes through the
interosseous space while still in
the posterior compartment of the
knee.

It ascends in front of the Popliteus,

which it supplies and anastomose
with the genicular anastomosis
Anterior tibial recurrent artery

It is given off
after the
interosseous
space, ascends on
the front and
sides of the knee-
joint to assists in
the formation of
the genicular
anastomosis
Muscular branches of the anterior tibial artery

Supplies the
muscles in the
anterior
compartment of the
leg (tibialis anterior,
extensor digitorum
longus, extensor
hallucis longus and
fibularis tertius)
Anterior medial and lateral malleolar arteries

Supply the medial

and lateral side of
the ankle
respectively form
anastomoses with
malleolar
branches from the
posterior tibial
artery .
Dorsalis Pedis Artery
The anterior tibial artery upon
reaching the tarsal or ankle region,
becomes the dorsalis pedis artery.

1. Medial tarsal artery.

2. Lateral tarsal artery.
3. Arcuate artery.
4. Deep plantar artery.
5. First dorsal interosseous artery.
Posterior Tibial Artery
 A Larger terminal branch of
popliteal artery.

 Begins at inferior border of

popliteus muscle.

 Descends on posterior surface of

tibialis posterior muscle.

 Itprovides blood to the muscles

and integument on posterior
compartment of the leg and plantar
surface of the foot.
Branches of the posterior tibial artery
1. Circumflex fibular
artery
2. Nutrient tibial
artery
3. Fibular/Peroneal
artery
4. Posterior medial
and lateral
malleolar artery
5. Medial and lateral
plantar artery
6. Calcaneal artery
Circumflex fibular artery
A branch of the
posterior tibial artery
which supplies blood to
the knee.

The artery winds

around the neck of the
fibula and takes part in
the genicular
anastomosis
Tibial nutrient artery
After given off
few muscular
branches which
enters the nutrient
canal of the tibia
bone to supply it
Fibular or peroneal artery

The posterior tibial artery

about 2.5cm from its origin,
gives the fibular or peroneal
artery branch, biggest branch
of the posterior tibial artery

It descends along the medial

side of the fibular to supply
supplies blood to the lateral
compartment of the leg.
Branches of the Fibular or peroneal artery

It then runs behind the tibiofibular syndesmosis

and divides into:
 Communication branch to anterior tibial artery.
 Muscular branches
 Communication branch to posterior tibial
artery
 Posterior lateral malleolar artery.
 lateral calcaneal artery.
Posterior tibial artery continues

Muscular branches
Posterior Medial
Malleolus
Medial Cancaneal
artery
Medial and lateral
plantar artery
(providing blood to the
plantar surfaces)
Plantar arch
The plantar arch is a
circulatory
anastomosis that
supply the plantar
surface formed by:
deep plantar artery
from the dorsalis
pedis artery of the
foot
lateral plantar
artery
FLOW CHART FOR LL SYSTEMIC CIRCULATION
Lower Limb Venous Drainage
The veins of the lower limb drain
deoxygenated blood and return it to
the heart.

They can be divided into two groups

– deep and superficial:
 Deep veins are located underneath
the deep fascia of the lower limb,
accompanying the major arteries and
sharing their names.
 Superficial veins are found in the
subcutaneous tissue. They eventually
drain into the deep veins (great
saphenous vein is formed by the
dorsal venous arch of the foot,
ascends up to receive tributaries
from other small superficial veins
and terminates by draining into the
femoral vein
Clinical anatomy
Peripheral Arterial
Occlusive Disease narrowing
of the wall of the arteries

Causes; Smoking, Diabetes

mellitus, Hypertension….

Treatment; Lifestyle changes,

diseases management, regular
exercise…..
Varicose veins
 Enlarged and twisted common in
the superficial veins in the leg
 Cause; loss of valves control to
prevent back flow.
 Symptoms; pain, swelling, skin
thickening.

 Treatment; Sclerotherapy
(procedure of medicine is injected
into the vessels, which makes them
shrink), vein stripping to remove
the affected veins and exercise