Arteries of Lower Limb

Deep Femoral Artery

Deep Femoral Artery is the main supplier of blood to the muscles of all the 3 compartments of the thigh and is the biggest branch of femoral artery. It originates by Lateral side of femoral artery in the femoral triangle about 4 cm below the inguinal ligament, on the rear side of the femoral vessels, while supplying medial and lateral circumflex arteries. It then goes downwards near to femur respectively between adductor longus and adductor brevis , between adductor longus and adductor magnus while entering posteriorly between pectinus and adductor longus.
The branches of profunda femoris artery are summarised as follows:
• Muscular branches.
• Medial circumflex femoral artery.
• Lateral circumflex femoral artery.
• 4 perforating arteries.

Femoral Artery

Femoral Artery is the main artery of the lower limb. It’s the continuance of external iliac artery and enters the femoral triangle behind the inguinal ligament at the midinguinal stage. It runs downward and medially successively via the femoral triangle and adductor canal. At the lower end of the adductor canal (i.e., at the junction of middle one-third and lower one-third of the thigh), it leaves the thigh via the adductor hiatus (a tendinous opening in the adductor magnus) to goes into the popliteal fossa where it continues as the popliteal artery.
It passes downwards and medially. first in the femoral triangle, and then in the adductor canal. At the lower end of the adductor canal, i.e., at the junction of the middle and lower thirds of the thigh it passes through an opening in the adductor magnus to become continuous with the popliteal artery.

Anterior Tibial Artery

Anterior Tibial Artery is an important artery of the anterior compartment of the leg. It is corresponding to the posterior interosseous artery of the forearm. The blood supply to the anterior compartment of the leg is bolstered by the perforating branch of peroneal artery. Hence, the size of peroneal artery is inversely proportional to that of the anterior tibial artery. It is the smaller terminal branch of popliteal artery given at the lower border of popliteus muscle.
It commences in the rear of the leg at the lower border of popliteus and enters the anterior compartment of the leg by passing forward between both heads of the tibialis posterior, via an opening in the upper part of the interosseous membrane.

Dorsal Pedis Artery

Dorsalis Pedis Artery is the main artery of the dorsum of the foot. The dorsalis pedis artery is the just the continuation of the anterior tibial artery. So it starts as the anterior tibial artery passes by the ankle joint. It is the direct continuation of the anterior tibial artery in front of the ankle.
Variations of dorsalis pedis artery: (a) In about 14% of cases, it could be replaced by the perforating branch of the peroneal artery, (b) It could be too large to compensate for the small lateral plantar artery of the sole of foot.
Branches
1. Medial artery
2. Lateral artery
3. Acruate artery
4. First dorsal metatarsal artery

Plantar Arteries

The medial plantar artery is the smaller terminal branch of the posterior tibial artery. It originates below the flexor retinaculum and appears in the sole deep to abductor hallucis escorted by the medial plantar nerve on its lateral side. They are of two types, medial and lateral.
• All the structures (example, chief neurovascular bundle and long flexor tendons) goes into the sole via a gap between the flexor retinaculum and the calcaneus referred to as porta pedis with the exception of the tendon of peroneus longus, which enters the sole via a groove underneath the cuboid named side gate of the sole.
• The passages for proximal and distal perforating arteries are named windows of the sole.

Obturator Nerve

The Obturator Artery originates from the anterior section of internal iliac artery in the pelvis. Through the obturator canal, it enters the adductor compartment of thigh. It divides into the medial and the lateral branches just outside the obturator canal. The acetabular branch that enters the acetabulum through the gap between acetabular notch and transverse ligament where it supplies acetabular fat and makes a small artery to the femoral head along with the head of the femur is made by lateral branch.
Generally a pubic branch of the obturator artery anastomoses with the pubic branch of the inferior epigastric artery. Sometimes this anastomosis is so large and well developed that the obturator artery appears to be a branch of the inferior epigastric artery.

Popliteal Artery

Popliteal artery is the extension of femoral artery. The starting point is adductor hiatus (an opening of osseo-aponeurotic type located in adductor magnusat , the junction of middle one-third and lower one-third of thigh), it gets divided into anterior and posterior tibial arteries when it comes across the floor of popliteal fossa by the medial to lateral side to reach the border of the popliteus.
Branches
• Cutaneous branches: They pierce the roof and supply the overlying skin.
• Muscular branches: They’re large and several in number. The upper branches (2 or 3 in number) supply adductor magnus and hamstring muscles.
• Genicular (articular) branches: They’re 5 in number and provide the knee joint.
1. Superior medial and lateral genicular arteries
2. Inferior medial and lateral genicular arteries
3. Middle genicular artery

Posterior Tibial Artery

Posterior Tibial Artery is the bigger branch of both terminal branches of the popliteal artery because its branches not only supply the posterior compartment but also the lateral compartment of the leg and the sole of the foot.
• It starts at the lower border of popliteus, between the tibia and fibula, deep to gastrocnemius and enters the rear of the leg by passing deep to the tendinous arch of soleus.
• Throughout its course, it’s escorted by the tibial nerve, which crosses the artery from the medial to lateral side
It can be felt against the calcaneum about 2 cm below and behind the medial malleolus, and in front of the medial border of the tendocalcaneus. Since the posterior tibial artery is located deep to the flexor retinaculum, it’s significant to request the patient to invert his or her foot to relax the flexor retinaculum.

Peroneal Artery

Peroneal Artery is the artery that provides blood to the lateral compartment of the leg. It’s the biggest and most important branch of the posterior tibial artery. It gives oxygenated blood supply to the posterior and lateral compartments of the leg.
• Muscular branches to the posterior and lateral compartments of the leg.
• Nutrient artery to the fibula.
• Communication branch: It joins with quite similar branch of the posterior tibial artery about 5 cm above the ankle.
• Perforating branch: It’s large and pierces interosseous membrane about 5 cm above the ankle, appears in theanterior compartment of the leg, and ends by anastomosing with the lateral malleolar branches of the anterior tibial and dorsalis pedis arteries.
• Lateral calcaneal artery: It’s a terminal branch which takes part in the formation of lateral malleolar plexus.