scholarly journals Absence of the genicular arterial anastomosis as generally depicted in textbooks

2013 ◽  
Vol 95 (6) ◽  
pp. 405-409 ◽  
Author(s):  
M Sabalbal ◽  
M Johnson ◽  
V McAlister
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Collateral Circulation ◽  
Lower Limbs ◽  
Direct Communication ◽  
Profunda Femoris Artery ◽  
Arterial Anastomosis ◽  
Lateral Circumflex Femoral ◽  
Profunda Femoris

Introduction Textbook representations of the genicular arterial anastomosis show a large direct communication between the descending branch of the lateral circumflex femoral artery (DBLCFA) and a genicular branch of the popliteal artery but this is not compatible with clinical experience. The aim of this study was to determine whether the arterial anastomosis at the knee is sufficient, in the event of traumatic disruption of the superficial femoral artery, to infuse protective agents or to place a stent to restore flow to the lower leg. Methods Dissection of ten cadaveric lower limbs was performed to photograph the arterial anatomy from the inguinal ligament to the tibial tubercle. Anastomosis with branches of the popliteal artery was classified as: ‘direct communication’, ‘approaching communication’ or ‘no evident communication’. Results A constant descending artery in the lateral thigh (LDAT) was found to have five types of origin: Type 1 (2/10 limbs) involved the lateral circumflex femoral branch of the femoral artery, Type 2 (3/10 limbs) the lateral circumflex femoral branch of the profunda femoris artery, Type 3 (1/10 limbs) the femoral artery, Type 4 (3/10 limbs) the superficial femoral artery and Type 5 (2/10 limbs) the profunda femoris artery. In one limb, there were two descending arteries (Types 4 and 5). Collateral circulation at the knee was also variable: direct communicating vessels (3/10 limbs); approaching vessels with possible communication via capillaries (5/10 limbs); no evident communication (2/10 limbs). Communicating vessels, if present, are too small to provide immediate collateral circulation. Conclusions Modern representations of the genicular arterial anastomosis are inaccurate, derived commonly from an idealised image that first appeared Gray’s Anatomy in 1910. The afferent vessel is not the DBLCFA. The majority of subjects have the potential to recruit collateral circulation via the LDAT following gradual obstruction to normal arterial flow, which may be important if the LDAT is removed for bypass or flap surgery. A direct communication is rarely present and is never as robust as generally depicted in textbooks.

scholarly journals Aberrant configuration of femoral vessels as cause of arterial occlusive disease

2018 ◽  
Vol 5 (5) ◽  
pp. 1962
Author(s):  
Ankit Ahuja ◽  
Vinay Naithani ◽  
Amit Kumar Bagara ◽  
Budhi Prakash Bhatia
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Relevant Literature ◽  
Arterial Occlusive Disease ◽  
Occlusive Disease ◽  
Lower Limbs ◽  
Clinical Implications ◽  
Profunda Femoris Artery ◽  
Femoral Vessels ◽  
Profunda Femoris

Variations in the branching pattern of femoral and profunda femoris arteries have clinical implications while performing various diagnostic imaging procedures as well as during surgeries that are performed in the femoral triangle. Awareness about these variations aid surgeons during preoperative clinical evaluation for surgical and interventional revascularization of the ileo-femoral and femoro-popliteal segments, in open canulation of femoral artery for cardiopulmonary bypass, in radiological interventions for A-V malformations, and in salvage operations for traumatic limb ischemia. Here we report an aberrant configuration of profunda femoris artery which presented as a case of arterial occlusive disease of lower limb. On surgical exploration, Profunda femoris artery was found originating on the medial aspect of left common femoral artery high up in the inguinal region as compared to its usual lower and lateral origin. There was atheromatous occlusion of superficial femoral artery from its origin upto distal femoral metaphysis. In case of occlusion of the superficial femoral artery, the profunda femoris artery forms an effective collateral bed between the ileo-femoral segment and the popliteal artery and its branches. The clinical implications associated with these variations in therapeutic and diagnostic interventions is been discussed along with relevant literature review. Further study is necessary to identify aberrant configuration of femoral vessels as a cause of arterial occlusive disease in the lower limbs.

A Variant Origin Of Profunda Femoris Artery and A Common Stem for the origin of Medial And Lateral Circumflex Arteries – A Case Report

2017 ◽  
Vol 1 (4) ◽  
Author(s):  
Pralhad D. S.
Keyword(s):  
Case Report ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Considerable Extent ◽  
Profunda Femoris Artery ◽  
Left Lower Limb ◽  
Profunda Femoris

The variations of the profunda and its branches are numerous and to a considerable extent, largely associated with one another. In occlusion of the superficial femoral artery, the profunda femoris artery forms an effective collateral bed between the ileo-femoral segment and the popliteal artery and its branches. Acharya Sushrutha has clearly mentioned about the importance of dissection., One who is intended to acquire definite knowledge of surgery should keenly study the anatomy from the books as well as from the dissection. Femoral artery is the most important artery supplying the lower limb and in case of cadavers this artery is used for the embalmment procedure. During the routine dissection classes for the UG’s, a variation was observed in the origin of profunda femoris and a common stem for the origin of medial and lateral circumflex arteries in the left lower limb.

A Synchronous Ipsilateral True Superficial Femoral Artery and Profunda Femoris Artery Aneurysm With Rupture: A Case Report and Review of the Literature

2020 ◽  
Vol 54 (7) ◽  
pp. 650-655
Author(s):  
Ali Ahmet Arıkan ◽  
Fatih Avni Bayraktar ◽  
Emre Selçuk
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Rare Condition ◽  
Review Of The Literature ◽  
Profunda Femoris Artery ◽  
Elderly Males ◽  
History Of ◽  
Profunda Femoris

Atherosclerotic true aneurysms of the superficial femoral artery (SFA) and profunda femoris artery (PFA) are rare and difficult to detect. The synchronous presence of SFA and PFA aneurysms is even rarer. Herein, we present a case with ipsilateral true SFA and PFA aneurysms diagnosed with rupture. A review of the international literature is made, and the diagnosis and treatment options of this rare condition are discussed. A 75-year-old male was admitted to our hospital with an aneurysm on the distal SFA and the ipsilateral PFA, as well as a hematoma around the PFA. It was difficult to determine the source of the rupture before surgery, even with proper imaging. Successful ligation of the PFA and an aneurysmectomy followed by a bypass grafting for the SFA were performed. An intraoperative examination revealed that the SFA aneurysm had ruptured. In elderly males with a history of ectasia or aneurysm on the aorta or peripheral arteries, a synchronous aneurysm on the SFA or the PFA should be suspected.

scholarly journals Relationship between upper and lower limb conduit artery vasodilator function in humans

2011 ◽  
Vol 111 (1) ◽  
pp. 244-250 ◽  
Author(s):  
Dick H. J. Thijssen ◽  
Nicola Rowley ◽  
Jaume Padilla ◽  
Grant H. Simmons ◽  
M. Harold Laughlin ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Femoral Artery ◽  
Brachial Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Lower Limb ◽  
Strong Predictor ◽  
Lower Limbs ◽  
Conduit Artery ◽  
Healthy Humans

Brachial artery flow-mediated dilation (FMD) is a strong predictor of future cardiovascular disease and is believed to represent a “barometer” of systemic endothelial health. Although a recent study [Padilla et al. Exp Biol Med (Maywood) 235: 1287–1291, 2010] in pigs confirmed a strong correlation between brachial and femoral artery endothelial function, it is unclear to what extent brachial artery FMD represents a systemic index of endothelial function in humans. We conducted a retrospective analysis of data from our laboratory to evaluate relationships between the upper (i.e., brachial artery) vs. lower limb (superficial femoral n = 75; popliteal artery n = 32) endothelium-dependent FMD and endothelium-independent glyceryl trinitrate (GTN)-mediated dilation in young, healthy individuals. We also examined the relationship between FMD assessed in both brachial arteries ( n = 42). There was no correlation between brachial and superficial femoral artery FMD ( r2 = 0.008; P = 0.46) or between brachial and popliteal artery FMD ( r2 = 0.003; P = 0.78). However, a correlation was observed in FMD between both brachial arteries ( r2 = 0.34; P < 0.001). Brachial and superficial femoral artery GTN were modestly correlated ( r2 = 0.13; P = 0.007), but brachial and popliteal artery GTN responses were not ( r2 = 0.08; P = 0.11). Collectively, these data indicate that conduit artery vasodilator function in the upper limbs (of healthy humans) is not predictive of that in the lower limbs, whereas measurement of FMD in one arm appears to be predictive of FMD in the other. These data do not support the hypothesis that brachial artery FMD in healthy humans represents a systemic index of endothelial function.

On-Site–Modified Sheath to Overcome the Undesirable Catheterization of the Profunda Femoris Artery During Antegrade Femoral Access

2020 ◽  
Vol 27 (3) ◽  
pp. 505-508 ◽  
Author(s):  
August Ysa ◽  
Marta Lobato ◽  
Amaia Arruabarrena ◽  
Ana M. Quintana ◽  
Roberto Gómez ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Common Femoral Artery ◽  
Simple Method ◽  
Femoral Access ◽  
Profunda Femoris Artery ◽  
Distal Marker ◽  
Antegrade Puncture ◽  
Repeated Passage ◽  
Profunda Femoris

Purpose: To present a simple method to avoid favored passage of a guidewire into the profunda femoris artery (PFA) after antegrade puncture of the common femoral artery. Technique: A 6-F conventional introducer sheath with a radiopaque distal marker is placed on the nurse’s table with its side port orientated to the 12 o’clock position. A small (2–2.5 mm) oval fenestration is created on the superior aspect of the sheath about 3 cm from its tip with a size 11 surgical blade. The modified introducer is passed over the angled 0.035-inch guidewire into the PFA and gently retrieved until the tip marker is ~3 cm from the femoral bifurcation. The dilator is removed, and the guidewire is withdrawn to the level of the fenestration, manipulated through it, and advanced further into the superficial femoral artery under fluoroscopic guidance. Conclusion: When repeated passage of the guidewire down the PFA persists despite conventional manipulation of the wire or needle, an on-site modification of the sheath is an easy alternative approach for the catheterization of the superficial femoral artery.

scholarly journals Variations in the Circumflex Branches of the Profunda Femoris Artery - A Cadaveric Study

2021 ◽  
Vol 10 (14) ◽  
pp. 1020-1024
Author(s):  
Anne George ◽  
Maheswary Thampi Santhakumary
Keyword(s):  
Femoral Artery ◽  
External Iliac Artery ◽  
Pubic Symphysis ◽  
Cadaveric Study ◽  
Anterior Superior Iliac Spine ◽  
Profunda Femoris Artery ◽  
Circumflex Femoral Artery ◽  
Medial Circumflex Femoral Artery ◽  
Lateral Circumflex Femoral ◽  
Profunda Femoris

BACKGROUND The external iliac artery passes behind the inguinal ligament into the front of the thigh as the femoral artery (FA). The FA gives off many branches both superficial and deep. The profunda femoris artery (PFA) is one of the deep branches given off in the femoral triangle in front of the thigh. The PFA gives off the medial circumflex femoral artery (MCFA) and the lateral circumflex femoral arteries (LCFA) and continues downwards giving off the first, second and third perforating arteries. The PFA terminates as the fourth perforating artery. Many variations in the circumflex branches of the PFA have been found by various authors. These variations are of great significance during procedures done in front part of the thigh. METHODS This is a descriptive cadaveric study. We dissected the thighs of 57 embalmed bodies. We looked for the medial (MCFA) and lateral (LCFA) circumflex arteries which are branches of PFA. Each artery was followed till its termination. The distance of their origin from the point of the origin of PFA from the FA was measured and noted. The distance between pubic symphysis and anterior superior iliac spine was measured using black silk and measuring scale. The midpoint was marked using skin marking pen and an incision extending from anterior superior iliac spine to pubic symphysis was made. Another incision was made from the above midpoint to the midpoint of a horizontal incision at the level of knee joint. Femoral sheath was identified and incised. Femoral artery, profunda femoris artery and its circumflex branches were identified. The modes of origin of MCFA and LCFA were noted. The distance of origin of these from the origin of PFA were measured. Variations in the branching pattern of MCFA and LCFA were looked for and noted down. RESULTS We found that in 83 % of the total cases MCFA took origin from PFA and its origin was from the FA in 13 %. In 84 % of total cases LCFA arose from PFA on the right side and 70 % on the left side. A common stump of origin was noted in 3 cases. CONCLUSIONS Medial and lateral circumflex branches of PFA exhibit wide variations. KEY WORDS Medial Circumflex Femoral Artery, Lateral Circumflex Femoral Artery, Variations in Origin and Branching

ANATOMICAL VARIATIONS OF THE ORIGIN OF PROFUNDA FEMORIS ARTERY – A CADAVERIC STUDY

2021 ◽  
pp. 4-6
Author(s):  
Indupuru Gowri ◽  
T. Sumalatha ◽  
Niveditha Samala
Keyword(s):  
Femoral Artery ◽  
Anatomical Variations ◽  
Lower Limbs ◽  
Inguinal Ligament ◽  
Lateral Side ◽  
Profunda Femoris Artery ◽  
Medical College ◽  
Medial Side ◽  
Femoral Triangle ◽  
Profunda Femoris

INTRODUCTION: The Profunda Femoris Artery (PFA) is a large branch arises from the lateral or posterolateral part of the Femoral Artery (FA), about 3 to 5cm below the inguinal ligament. The PFA is in close proximity to femoral vessels in the femoral triangle the precise anatomical knowledge of PFA and its branches is of great signicance in preventing profuse haemorrhage, pseudo aneurysms and traumatic AV stulae while doing any procedures or surgeries in that area. AIM & OBJECTIVES: To study the anatomical variations in source of origin, site of origin and distance of origin from midpoint of inguinal ligament of PFA. MATERIALS AND METHODS: The present observational study was conducted on the dissection of 70 lower limbs of 35 adult cadavers (27 male & 8 female) in the Department of Anatomy S.V.S Medical College, Mahabubnagar over a period of 2 years. Contents of the femoral triangle were dissected as per Cunningham's manual. The source of origin, site, distance of origin from mid points of inguinal ligament and course of PFA were noted. Collected data was analysed statistically. RESULTS: In the present study the PFA was arising from the femoral artery in all these 70 Lower Limbs. The commonest site of origin of PFA was postero lateral side of femoral artery in 17 (48.6%) Limbs on right side, 16(45.8%) limbs on left side, followed by lateral side of FA in14(40%) limbs on right side, 12(34.3%) limbs on left side ,followed by posterior in 4(11.4%) limbs on each side. The PFA was originating from medial side of FA only in 3 (4.29%) left limbs The PFA was taking origin below the inguinal ligament most commonly at the distance of 3-4cm in 10(29) limbs on right side, 15(43%) limbs on left side and at 4-5cm in 8(23%) limbs on right side, 5(14%) limbs on left side, at 2-3cm in 8 (23%) limbs on right side, 6(17%) limbs on left side, at 5-7cm in 3(8.5%) limbs on right in 1 (3%) limbs on left side. The PFA was taking origin higher level with in 2cm below the midpoint of inguinal ligament in 6 (17%) limbs on right side, 8(23%) limbs on left side. CONCLUSIONS: The knowledge of site and level of origin of Profundafemoris artery helps in avoiding the formation of iatrogenic femoral arteriovenous stula (0.1-1.5%) while performing femoral artery puncture during femoral puncture, cardiac catheterisation and radiological procedures

Crush implantation of a self-expanding interwoven stent over a subintimally recanalized standard stent in a TASC D lesion of the superficial femoral artery

VASA ◽  
2012 ◽  
Vol 41 (6) ◽  
pp. 458-462 ◽  
Author(s):  
Vogel ◽  
Strothmeyer ◽  
Cebola ◽  
A. Katus ◽  
Blessing
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Popliteal Artery ◽  
Duplex Ultrasound ◽  
Stent Fracture ◽  
Nitinol Stent ◽  
Nitinol Stents ◽  
Walking Capacity ◽  
Radial Strength ◽  
Good Treatment Option

We demonstrate feasibility of implantation of a self-expanding interwoven nitinol stent in a claudicant, where recanalization attempt of a heavily calcified, occluded superficial femoral artery (TASC D lesion) was complicated by a previously implanted, fractured standard stent. Wire passage through the occlusion and beyond the fractured stent could only be achieved through the subintimal space. A dedicated reentry device was used to allow distal wire entry into the true lumen at the level of the popliteal artery. Despite crushing of the fractured stent with a series of increasingly sized standard balloons, a significant recoil remainded in the area of the crushed stent. To secure patency of the femoro-popliteal artery we therefore decided to implant the novel self-expanding interwoven nitinol stent (Supera Veritas (TM), IDEV), whose unique feature is an exceptional high radial strength. Patient presented asymptomatic without any impairment of his walking capacity at three month follow up and duplex ultrasound confirmed patency of the stent. Subintimal recanalizations can be complicated by previously implanted stents, in particular in the presence of stent fracture, where intraluminal wire passage often can not be achieved. Considering the high radial strength and fracture resistance, interwoven nitinol stents represent a good treatment option in those challenging cases and they can be used to crush standard nitinol and ballonexpandable stents.

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