Page 3 - Carotid and peripheral vascular interventions textbook
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                                 Deep circumflex iliac
                                                                              External iliac
                             Superficial circumflex iliac
                                                                             Inferior epigastric

                                                                             Superior epigastric
                            Ascending branch of lateral
                                  femoral circumflex
                                                                             Common femoral
                     Transverse branch of lateral femoral
                                                                             Deep pudendal

                                                                             Medial femoral circumflex
                          Descending branch of lateral
                                  femoral circumflex
                            Lateral femoral circumflex                       Muscle branches
                                   Profunda femoris

                                                                          Adductor hiatus (Hunter’s canal)
                                                                          Descending genicular
                                             Popliteal                    Articular branch of descending genicula
                                 Superior lateral genicular               Saphenous branch of descending genicular
                                   Patellar anastomoses                   Superior medial genicular
                                  Inferior lateral genicular              Inferior medial genicular
                                 Circumflex fibular branch
                                        of anterior tibial               Anterior tibial recurrent

                                          Anterior tibial
                                                                         Posterior tibial
                 Figure  12-1.  Normal anatomy of femoropopliteal artery. (redrawn from

                    The PFA emerges from the lateral aspect of the CFA   COLLATERAL CIRCULATION
                and travels posteriorly, and laterally, to the SFA. It gives
                off two major branches proximally, the medial and lateral      The lower extremity has complex and abundant
                circumf ex femoral branches (Fig. 12-1). One of both of   collateral circulation systems which maintain the leg’s   331
                these branches may occasionally (i.e., about 15 to 20%)   blood f ow when there are obstructions within proximal
                arise directly from the CFA. In its mid- and distal portion,   arteries. The main pathways are provided by branches
                the PFA typically produces three perforating branches    of the PFA and popliteal arteries:
                to the thigh muscles. Proximally, the medial and lateral     •  SFA occlusion: Collaterals rely depend on the site
                circumf ex branches and the primary perforating branch   and length of the occlusion. The PFA is the major
                have connections with the internal iliac artery branches   conduit to the lower leg, with perforating and
                (i.e., superior and inferior gluteal, and obturator branches).   lateral femoral circumf ex branches (Fig. 12-1)
                Distally, the lateral circumf ex artery and the perforating   supplying branches of the popliteal, and distal
                branches have important connections with the collateral   SFA arteries.
                network at the knee joint, which connect with the popliteal     •  Deep femoral or PFA occlusion: Internal iliac
                and tibial vessels. Through these proximal and distal   artery branches to lateral and medial circumf ex
                connections, the PFA produces a vital supply of collateral   femoral branches of the PFA.
                f ow to the foot and leg, in those patients with signif cant   •  Popliteal artery occlusion: Sural collateral and
                SFA occlusion or stenoses.                            geniculate network.
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