Vasculature of the

Lower Extremity
Anatomy Dissection 4/7/15
Erin Shropshire PGY-1

Anatomy Overview
Femoral Triangle

Inguinal
Ligament
Sartorius
m.
Adductor
Longus m.

Venous Anatomy

Varicose Veins
Varicose veins affect 1 in 2
people older than age 50, and
15-20% of all adults

Risk Factors:
Increasing age
Family history
Long periods sitting and/or
standing
Obesity
Pregnancy
Symptoms:
Aching, throbbing, leg fatigue
Skin changes
Pigmentation and scarring
Visible and unsightly veins

How can I treat these?

Less than 10% of varicose veins

treated with ablation return after
2 years

Anatomy Overview
Anterio
r

Femoral Vessels
External Iliac a.
Common
femoral a.
Superficial femoral
a.
Deep femoral a.;
Deep a. of the
thigh;
Profunda femoris
a. Popliteal a.

Posteri
or

Adductor
(Hunters)
canal

Adducto
r Hiatus

Hunters Canal

Contains:
Femoral Artery
Femoral Vein
Saphenous Nerve
Nerve to Vastus Medialis
Borders:
Anterior - sartorius
Posterior - adductors longus/magnus
Lateral - vastus medialis
Adductor Canal Outlet Syndrome
Thrombosis of the SFA at the outlet
Mechanical trauma where the
femoral artery crosses the adductor
magnus tendon
Causes intimal injury and
thrombosis
Can also have femoral v.
compression within the canal

Anatomy Overview
Femoral Vessels

SFA

Profund
a
SFA

Profunda

Popliteal
a.

Anatomy Overview
Medi
al

R
leg

Popliteal Fossa
Later
al

Biceps femoris m.
(most lateral
hamstring)

Semimembranosu
s m.
(most medial
hamstring)

Popliteal a.

Plantaris m.
Gastrocnemius m.
(lateral and medial
heads)

Anterio
r

Anatomy Overview
Lower Leg
Popliteal a.
Anterior tibial
Tibial-fibular
a.
(peroneal) trunk
Fibular (peroneal)
a.

Posterior
tibial

Dorsalis
pedis

Posteri
or

Surgical Points
Lower Leg Angio
Popliteal

Anterior
tibial

Fibular
(peronea
l)
Posterior
Tibial

Dorsalis

Lateral View

Surgical Points

Surgical Points
popliteal exposure

Incision on
superior-medial
calf just posterior
to tibia
Expose deep
posterior
compartment
(open fascia)
Retract
gastrocnemius
and soleus
posterior and
adductor anterior
Uses:

Clinical Points

ABI

Clinical correlation

<0.9

Start to get claudication

<0.5

Start to get rest pain

<0.4

Ulcers

<0.3

Gangrene

Sabisto
ns

Absite

Clinical Points

Clinical Points
Medical Treatment of
PAD
Risk factor modification
Exercise training (distance goals)

Pharm:
Pletal (Cilostazol): PDE3
inhibitor
Inhibits platelet aggregation
Artery dilation
Trental (pentoxifylline):
xanthine derivative; non
selective PDE inhib
Decreases blood viscosity
Increases RBC ability to
deform

Clinical Points
Compartment Syndrome

Acute Compartment
Syndrome
open and closed fractures
Ischemia/reperfusion (46hrs)
Burns
Crush injury
Constrictive dressing/cast
Snake bites

Symptoms
6 Ps
Pain
Pallor
Pulseless
Poikilothermia
Paraesthesias
Paralysis

Anterior
compartme
nt
Lateral compartment
Deep posterior
compartment

Superficial posterior
compartment