Arteries
The femoral artery (femoralis s. cruralis ; French: artère fémorale ), is that portion of the artery of the lower limb which lies along the upper two-thirds of the thigh, — its limits being marked, above, by Poupart's ligament, and below, by the opening in the great adductor muscle, after passing through which the artery assumes the name popliteal.
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Terminal branches of the posterior tibial artery.
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Frequent mention has been made of the anastomoses which exist between the branches of the arteries in the lower limb ; and a general view of them may now be taken in order that some idea may be formed of the important influence which they exert in maintaining the circulation of the limb, when the principal artery is obliterated by an operation, or by disease.
It may be remarked, in the first place, that the more important of these anastomoses occur in the neighbourhood of the principal articulations of the limb.
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The peroneal artery, [a. peronea] lies deeply along the back part of the leg, close to the fibula : hence its names, peroneal or fibular. Arising from the posterior tibial artery, about an inch below the lower border of the popliteus muscle, it inclines at first obliquely towards the fibula, and then descends nearly perpendicularly along that bone and behind the outer ankle, to reach the side of the os calcis.
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From the facts above-mentioned, concerning the peculiarities of the three arteries which supply the leg and foot, it will be seen that all the deviations from the ordinary arrangement, in regard to their size, display a general principle of compensation, by which deficiencies in one vessel are balanced by an increase in the size of another.
It will also be observed, that, whilst the anterior and posterior tibial arteries have a greater tendency to diminish than to increase in size, the peroneal artery, on the contrary, is the vessel which is the most frequently enlarged. The anterior and posterior tibials, however, occasionally assist each other, especially in the supply of arteries to the toes.
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The posterior tibial artery [a. tibialis postica] is situated along the back part of the leg, between the superficial and deep layers of muscles, being firmly bound down to the latter by the deep fascia.
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The peculiarities of this artery relate to its origin, its course, its size, and the condition of its branches.
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The popliteal artery [a. poplitea], at the back of the knee-joint, extends along the lower third of the thigh and the upper part of the leg, reaching from the opening in the great adductor to the lower border of the popliteus muscle. It is continuous above with the femoral, and divides at the lower end into the anterior and posterior tibial arteries.
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The dorsal artery of the foot (a. dorsalis pedis), the continuation of the anterior tibial artery, extends from the termination of that vessel at the bend of the ankle, to the posterior end of the first metatarsal space, where it divides into two branches, of which one proceeds forwards in the first interosseous space, whilst the other dips into the sole of the foot, and terminates by inosculating with the plantar arch. This vessel, in its course forwards, rests upon the astragalus, the scaphoid, and internal cuneiform bones and their respective articulations. It lies in the interval between the tendon of the proper extensor of the great toe, and that of the long extensor of the other toes ; and is covered by (besides the integument) the fascia of the foot, and by a layer of dense cellular membrane, which binds it to the parts beneath. Near its end, it is crossed by the innermost tendon of the short extensor of the toes.
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The femoral artery is accessible to the surgeon for the application of a ligature without serious difficulty in its entire length ; but as the lower half is deeply placed, the difficulty of reaching this part is greatest, at the same time that the depth at which the vessel lies renders it necessary to divide and disturb the surrounding structures to a greater extent than where the vessel is nearer the surface. For these reasons the upper part of the artery is to be preferred for the performance of the operation adverted to, in all cases in which other circumstances do not control the choice of the surgeon. But the upper part of the femoral artery is not equally eligible for the application of a ligature at all points, in consequence of the position of the branches — an important consideration in the surgical anatomy of this vessel.
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The anterior tibial artery, [a. tibialis antica,] placed along the fore part of the leg, is at first deeply seated, but, as it descends, gradually approaches nearer to the surface. It extends from the division of the popliteal artery to the bend of the ankle, whence it is afterwards prolonged to the interval between the first and second metatarsal bones, under the name of dorsal artery of the foot.
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The external circumflex artery, [circumfiexa femoris interna s. posterior,] a branch of considerable size, arises from the outer side of the profunda, and, after passing outwards for a short distance beneath the sartorius and rectus muscles, and through the divisions of the anterior crural nerve, gives branches, which may be divided into three sets, according to the directions which they take.
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