Femoral artery

Topography and course of the artery

The vessel begins its course by exiting the pelvic cavity below the inguinal ligament through the vascular lacuna (lacuna vasorum). Immediately after this, it enters the femoral triangle (Scarpa's triangle). Here, the trunk lies lateral to the femoral vein of the same name and medial to the femoral nerve (n. femoralis). The artery lies upon the pectineus muscle (m. pectineus) and the adductor longus muscle (m. adductor longus), being covered by the fascia lata and the sartorius muscle (m. sartorius).

Next, the vessel enters the adductor canal (Hunter's canal, canalis adductorius). This canal has three walls:

• Medial: adductor magnus muscle (m. adductor magnus).
• Lateral: vastus medialis muscle (m. vastus medialis).
• Anterior: dense fibrous lamina (lamina vastoadductoria).

Passing through the canal, the vessel leaves it via the lower aperture — the tendinous hiatus (hiatus adductorius), enters the popliteal fossa, and continues as the popliteal artery (a. poplitea). It is important to note that within the canal, the femoral nerve lies anterior and lateral to the artery, which surgeons must account for during surgical approaches.

Superficial branches

At the very beginning, three superficial branches arise from the main trunk and pierce the cribriform fascia (fascia cribrosa):

1. Superficial epigastric artery (a. epigastrica superficialis) — runs anteriorly and superiorly along the anterior abdominal wall toward the umbilicus. It forms anastomoses with the superior and inferior epigastric arteries.
2. Superficial circumflex iliac artery (a. circumflexa ilium superficialis) — runs laterally along the inguinal ligament toward the anterior superior iliac spine (spina iliaca anterior superior), supplying the skin and lymph nodes of this region.
3. External pudendal arteries (aa. pudendae externae) — divide into superficial and deep branches. They run medially toward the scrotum or labia majora, as well as the skin of the perineum. They actively anastomose with branches of the internal pudendal artery.

Deep artery of the thigh

Deep artery of the thigh (a. profunda femoris) — is the largest branch and the main source of blood supply to the muscular mass of this region. Below the level of its origin, the main trunk itself supplies predominantly the skin and adductor muscles. It arises 3–5 cm below the inguinal ligament from the posterior (or posterolateral) circumference of the femoral trunk, runs deep, and descends to the lower third of the thigh.

Its most important branches:

• Medial femoral circumflex artery (a. circumflexa femoris medialis). Runs posteriorly and medially, winding around the femoral neck. Through its acetabular branch (r. acetabularis), it provides critically important blood supply to the head of the femur. Due to injury to this branch, medial femoral neck fractures are frequently complicated by severe avascular necrosis.
• Lateral femoral circumflex artery (a. circumflexa femoris lateralis). Runs laterally beneath the rectus femoris muscle and divides into ascending, transverse, and descending branches. The latter reaches the knee joint and participates in the formation of the genicular articular network (rete articulare genus).
• Perforating arteries (aa. perforantes). Three robust vessels pierce the tendons close to the bone, emerging on the posterior surface of the thigh. They supply the posterior muscle group and the femur itself (aa. nutriciae femoris), forming a continuous chain of anastomoses.

Descending genicular artery

Descending genicular artery (a. descendens genus) — the last and most distal branch. It arises within the adductor canal. Unlike the main trunk, it leaves the canal not through the lower, but through the anterior aperture in the fibrous lamina, emerging onto the thigh together with the saphenous nerve (n. saphenus).

It gives off the saphenous branch (r. saphenus) for the skin of the medial surface of the leg and articular branches (rr. articulares). The latter run to the medial side of the knee joint, forming the isolated patellar network (rete patellare) and contributing to the common genicular articular network. With slow occlusion of the popliteal artery (e.g., in atherosclerosis), this vessel enlarges and serves as a vital collateral pathway.

Cruciate anastomosis

On the posterior surface of the thigh, at the level of the lesser trochanter, the so-called cruciate anastomosis (anastomosis cruciata) is formed. Four arterial sources converge in it:

This junction is of tremendous clinical significance. If the external iliac or the initial segment of the femoral artery is blocked by a thrombus or plaque, blood from the internal iliac artery system via the gluteal vessels enters the cruciate anastomosis and subsequently into the deep artery of the thigh. Thus, the limb is rescued from ischemia.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Anastomoses around the knee joint (Rete articulare genus)
• Plantar arch and arteries of the foot
• Arterial networks of the ankle joint (medial and lateral malleolar networks)
• "Corona mortis" and its surgical significance
• Summary table of arterial anastomoses of the trunk and limbs

Other topics in the "Angiology" section

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