Blood Supply of Lower Limb (Viva)

ARTERIAL SUPPLY OF LOWER LIMB

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 Q.1 What are the branches of the femoral artery?

• The branches of the femoral artery can be either superficial or deep.

The superficial branches include:

– Superficial circumflex iliac artery
– Superficial epigastric artery
– Superficial external pudendal artery

The deep branches include:

– Deep external pudendal artery
– Profunda femoris artery
– Descending genicular artery

Q.2 What is the extent of the femoral artery?

 It begins at mid inguinal point and ends at the medial side of middle and lower one-third of the thigh by passing through an aperture in adductor magnus muscle to reach back of thigh and become popliteal artery.

Q.3 Name the branches of profunda femoris.

• Lateral circumflex femoral artery
• Medial circumflex femoral artery
• Perforating arteries
• Muscular branches.
  
  

Q.4 Name the arteries forming the cruciate anastomosis.

• Inferior gluteal artery
• First perforating artery
• Transverse branch of the medial circumflex femoral artery
• Transverse branch of lateral circumflex femoral artery.
  
  

Q.5 Name the arteries forming the trochanteric anastomosis.

• Descending branch of superior gluteal artery
• Ascending branch of the medial circumflex femoral artery
• Ascending branch of the lateral circumflex femoral artery.
  
  

Q.6 How the circulation is maintained in case of blockage of femoral artery?

In blockage in the proximal part, circulation is maintained through cruciate and trochanteric anastomosis. When the blockage is in lower thigh then circulation is maintained through perforating branches of the profunda femoris artery and its anastomoses with branches of the popliteal artery.

Q.7 Name the branches of the popliteal artery.

• Cutaneous branches
• Superior muscular branches:
  To adductor magnus and hamstrings
• Sural arteries:
  To gastrocnemius, soleus and plantaris.
• Superior genicular arteries:
  Medial and lateral
• Middle genicular artery
• Inferior genicular arteries:
  Medial and lateral
• Terminal branches:
  Anterior and posterior tibial arteries
  
  

 Q.8 What are the relations of the anterior tibial artery in anterior compartment of the leg?

• Relation to muscles:

- In upper 1/3, lies between tibialis anterior and extensor digitorum longus.
- In the middle 1/3, lies between tibialis anterior and extensor hallucis longus.
- In lower 1/3, lies between extensor hallucis longus and extensor digitorum longus.

• To veins: Artery is accompanied by two venae comites.
• To nerve: Deep peroneal nerve is lateral to it in upper 1/3 and lower 1/3 and anterior to it in middle 1/3.

Q.9 What are the branches of anterior tibial artery?

• Muscular branches.
• Recurrent branches: Anterior and posterior tibial
• Malleolar branches: Anterior medial and anterior lateral.
  
  

Q.10 How dorsalis pedis artery is formed?

It is the continuation of the anterior tibial artery in front of the ankle between the two malleoli.

Q.11 Name the branches of dorsalis pedis artery.

• Lateral tarsal artery
• Medial tarsal artery
• Arcuate artery
• First dorsal metatarsal artery.
  
  

Q.12 Where the pulsations of dorsalis pedis artery are felt?

Between the tendon of extensor hallucis longus and first tendon of extensor digitorum longus on dorsum of foot about 5 cm distal to medial and lateral malleoli, over intermediate cuneiform bone.

Q.13 Name the branches of the posterior tibial artery.

• Peroneal: Largest branch
• Muscular
• Nutrient artery to tibia
• Anastomotic branches:
  – Circumflex fibular
  – Communicating branch to peroneal
  – Malleolar
  – Calcaneal

• Terminal branches: Medial and lateral plantar.
  
  

Q.14 To which bone peroneal artery gives a nutrient artery?

Fibula

Q.15 Which artery forms the plantar arch?

Lateral plantar artery

Q.16 How the lateral plantar artery terminates?

It ends by joining the termination of dorsalis pedis artery in the interval between the bases of the first and second metatarsal bone.

 

VENOUS DRAINAGE

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Q.1 What are the different factors that facilitate the return of venous blood to the heart?

• Local factors:

 – Veins of the lower limbs are larger than veins of other parts of the body. They also have a greater number of valves, which prevent the backflow of blood.

– Muscular contraction compresses the deep veins and drives the blood upwards.

– Muscular compression of veins is made more effective by tight deep fascia.

• General factors:

– The valves which maintain a unidirectional flow.

– Negative intrathoracic pressure, which pulls the column of blood up, and it is made more negative during inspiration.

– Vis-a-tergo (compulsion from behind) produced by arterial pressure and overflow from the capillary bed.

Q.2 What are the main superficial veins of the lower limb?

• Great saphenous vein:
  Continuation of medial marginal vein of foot. It ascends into the thigh and after passing through a saphenous opening in deep fascia ends in the femoral vein. It receives superficial epigastric, superficial circumflex iliac, external pudendal, anterior vein of the leg, and posterior arch veins.
  
  
• Anterior cutaneous vein of the thigh:
  Drains front of the lower part of the thigh and it drains into the great saphenous vein.
  
  
• Short saphenous vein:
  Continuation of the lateral marginal vein of foot and ends in the popliteal vein above the knee joint.
  
  
• Perforating veins:
  These are the veins connecting superficial veins with the deep veins after perforating the deep fascia. They permit only unidirectional flow of blood, from superficial to deep veins by means of valves. These are present both in thigh and leg, but a number of these are present in lower one-third of the leg.

Q.3 What is ‘calf pump’ or ‘peripheral heart’?

In an upright position, venous return from lower limb depends largely on the contraction of calf muscles, these are known as calf pumps,& the soleus is called “peripheral heart” for same reason.

Q.4 What are varicose veins?

If the valves in veins become incompetent, the pressure during muscular contraction is transmitted from deep veins to the superficial veins and hence, leakage of blood. This causes dilatation of the superficial veins, known as varicose veins. Later on, gradual degeneration occurs, leading to “varicose ulcers”.

Q.5 What is the clinical importance of sural sinuses?

Sural sinuses are the common site for thrombosis and commonly leads to pulmonary embolism due to the detachment of thrombus.

 

LYMPHATIC DRAINAGE OF LOWER LIMB

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Q.1 What is the lymphatic drainage of various inguinal lymph nodes?

• Upper lateral superficial group:
  Drains skin of anterior abdominal wall below the umbilicus.
  
  
• Upper medial superficial group:
  Drains skin of anterior abdominal wall below the umbilicus, external genitalia except for glans penis or clitoris, the lower part of the anal canal and lower part of the vagina and some lymphatics from the inguinal canal.
  
  
• Lower superficial inguinal group:
  Drains superficial lymphatics of lower limb except from back of leg.
  
  
• Deep inguinal group:
  Drains deep lymphatics of thigh, glans penis or clitoris, and popliteal lymph nodes.
  
  
• Popliteal lymph nodes:
  Drains deep lymphatics of foot and leg and superficial lymphatics of back of leg.
  
  All lymphatics from inguinal nodes drain into external iliac lymph nodes.

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