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Femoral sheath and canal anatomy

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Summary

Core Theme

The femoral sheath is a crucial fascial tube in the inguinal region that surrounds the femoral artery and vein, facilitating their passage and function between the torso and the lower limb, and its associated canal is a potential site for hernias.

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the anatomy of the femoral sheath you're

not going to be a lot of use are you

because you haven't got

much else other than bones on you the

anatomy of the femoral sheath so it's

down here in the inguinal region

what is it

what's in it

and why is it useful

and what might i get it confused with

that's what we'll do because there's a

lot of similar words around there

and sam this isn't there isn't a lot you

can say about the femoral sheath so

don't make this a long one [Music]

the femoral

sheath what

is it well it's uh

it's connective tissue one of the unsung

heroes of the body right

is a bit of cling film that might be so

it's it's fascia

so we have facial sheets

around the body

which hold everything together

and help give us our shape and help hold

everything together help everything move

if you didn't have fascia

you'd be quite different

so it's it's fascia

and we need to look down here

taken the gastrointestinal tract out mostly

mostly

so we can see the bladder structures of

the pelvis there and we can see some

muscles of the posterior abdominal wall

major blood vessels

and muscles of the

anterolateral abdominal walls so fascia

fascia

the innermost muscle of the three layers

forming the abdominal wall is um

transversus abdominis and it is lined on

its internal surface by transversalis

fascia a sheet of connective tissue that

is not particularly stretchy and is

quite strong and tough and that sort of thing

thing

this big muscle here this big chunky muscle

muscle

is psoas major so this major is one of

and this muscle here is iliacus

and iliacus and so this major come

together they get called iliopsoas and

those muscles are also covered in fascia

fascia

which you would call the iliopsoas

fascia or the bit over the source the so

you see

the fascia is sensibly named so the

iliopsoas fascia is helping hold all of

those muscle units together

now here

this is the inguinal ligament this is

like the boundary between the abdominal

pelvic cavity the torso

and the lower limb

and some things have to pass into the

lower limb like blood vessels and nerves

and we'll get to those

so the inguinal ligament like acts as a

like as a strap there's a retinaculum

elsewhere in the body if you know about

that sort of thing so the inguinal

ligament ties everything down at the hip

for when we make

hip movements right it stops it all

slipping out

so what happens is is the transversalis

fascia and the iliopsoas fascia

huh it's like it's doing it already come

together to form a tube

the femoral sheath and that tube passes

deep to the inguinal ligament and into

the upper thigh except it's not a tube

it's more of a funnel that is it's

narrower at the bottom and wider at the top

top

and it

in the upper thigh

it ends by blending with the adventitia

the connective tissues of the blood

vessels and that is the femoral sheath

it's a fascial funnel

funnel

or tube

deep to the inguinal ligament

surrounding the blood vessels but not

the nerve it's about three to four

centimeters long

it's deep to the inguinal ligament oh by

the way see this fascia here this is the

fascia latae

the connective tissue the fascia

covering the muscles of the lower limb

and all the deeper vessels and stuff

and um the

the

femoral sheath is essentially deep to

the fasciae latae we'll talk about this

hole in other bits and bobs here in a moment

moment

okay so the femoral sheath

runs deep to the inguinal ligament

and is a connective tissue tube connecting

connecting

the torso with the lower limb

now there's more to it than that inside

the femoral sheath

it is divided up into three compartments

so there are three tubes within the tube

and what are in those tubes

the femoral artery

in the lateral compartment

the femoral vein

in the intermediate compartment in the

middle and then in the medial compartment

compartment

closest to this side

there is nothing

that's not true but it's an important

idea so the the medial compartment is

essentially it's like an empty space actually

actually

we see

we see lymphatics running in there we

can see a lymph node up there

so we get these deep

inguinal lymph nodes

the the lymph node

that deep inguinal lymph node one of

like the first ones the most inferior

ones that we find

in the

medial compartment of the femoral sheath

um gets referred to as uh the lymph node

of cloquet cloquet cloquet or rosen muller

muller

but we also have lymphatic vessels in

there if we're adding detail then in the

the lateral compartment

with the femoral artery we will also

find the femoral branch of the genito

femoral nerve

store that someplace for another day i'm

not going to come back to that all right

that's it then right femoral sheath and

ah there's more though isn't there what

about the femoral nerve okay so the

femoral artery what happens is is the

femoral artery is actually a

continuation of the external iliac

artery and when it passes deep to the

inguinal ligament we change its name and

it becomes the femoral artery likewise

the femoral vein when it passes deep to

the inguinal ligament we change its name

and becomes the

external iliac vein but what we don't

see on here is the nerve and that's kind

of important

i say that it's important because it's

easy to get confused around here but

here we go here's the left side look so

there's the femoral artery

vein and nerve so the nerve is lateral

the vein is medial

femoral nerve femoral artery femoral

vein so the femoral artery and the

femoral vein are within the femoral sheath

sheath

in their own compartments but the

femoral nerve is not

it passes deep to the inguinal ligament

but it is outside the femoral sheath it

is lateral to the femoral sheath

what is the purpose of this connective

tissue well

we have as i said we when we

move this joint we have these major

blood vessels passing from the torso to

the lower limb we do not want them to be kinked

kinked

like a hose pipe or folded or impeded in

any way because they're supplying blood

to all these muscles of the lower limb

and draining it back again so the

femoral sheath

lets these blood vessels slide up and

down as we move the hip joint that's the

first one now

now

add a little bit more detail

you remember i said there were three compartments

compartments

to the femoral sheath and

and

the lateral compartment holds the

femoral artery the intermediate

compartment in the middle holds the

femoral vein and the medial compartment

has some lymph nodes but is otherwise

empty now that empty part that empty tube

tube

that gets called the femoral canal

so don't mix up femoral canal and sheath

which is very easy to do so the

connective tissue is the sheath that

makes sense the connective tissue makes

a sheath right

the space within the sheath is the canal

because the canal is a space

now the reason the femoral canal exists is

partly because of that sliding up and

down thing

but also if

the blood flow from the lower limb increases

increases

the vein can dilate so veins um

veins don't have muscular walls they can

stretch more easily than arteries right

so if more blood is coming back the

femoral vein can dilate into that empty

space of the femoral canal there's room

to which for it to stretch out into right

right

also remember that while the blood

inside arteries is arterial pressure

obviously it's at high pressure the

blood inside the veins is at low

pressure and this blood is being drawn

back from the upper limb all the way up

the torso to the heart which is a long ways

ways

it's more being sucked up than pushed up right

right

which means that if you were to

increase the pressure inside your torso

through a valsalva maneuver you know

straight or if you're lifting something

and straining or

you're voiding your bowels or whatever

if you increase the pressure inside the

torso then it's going to impede the

venous return into the torso because the

pressure will be too high and that means

that the femoral canal then gives some

all right so that's the relevant anatomy

but there's more

what other terms or phrases around here

might we confuse these terms with okay well

well

um the other thing here is the femoral triangle

so the femoral triangle describes this

region the femoral triangle is made from

the borders of the inguinal ligament the

sartorius muscle and abductor longus so

the femoral sheath

is within the femoral triangle

the femoral sheath is the connective

tissue the femoral triangle is that

triangle that we've defined there

but there are other canals right let's

go back to the

other one

the inguinal ligament

also has an inguinal canal nearby so the

inguinal canal is different to the

femoral canal the inguinal canal is made

from the muscles of the abdominal wall

curving around and making a tube so it's

a muscular tube

it is superior to the inguinal ligament and

and

it carries the spermatic cord and that

sort of thing so it links the contents

of the scrotum with the

abdominal pelvic cavity right so the

femoral canal

is within the femoral sheath

it runs deep to the inguinal ligament so

it connects the torso with the lower limb

limb

the inguinal canal

is superior to the

inguinal ligament it's a muscular tube

and it connects the scrotum or the labia majora

majora

with the abdominal pelvic cavity okay

we can see part of that here

i said this was the fascialata

the connective tissue the fascia

covering of the lower limb

uh the major vein that we can see here

superficial to that is the great

saphenous vein

big superficial vein of the lower limb

there is an opening here this is the

saphenous opening or the saphenous ring

and the great saphenous vein passes

through that opening so that's how it

gets from superficial to the fascialata

to deep to the fascia later and there it

drains into

the femoral vein

if the femoral sheath has continued down

to that point then the great saphenous

vein will also go through the femoral

sheath to get to the femoral vein so

saphenous opening

but those are the things that you might

um well worth knowing about and get

confused in that sort of thing the

femoral canal

also has a femoral ring

which is where we see it opening

hernia

so um bowel

bowel

because of the high pressures in here can

can

find itself find its way out of

the abdominal cavity through weaknesses

the femoral

canal within the femoral sheath is a

potential route for a loop of bowel to

pass inferiorly

deep to the inguinal ligament and into

the femoral triangle

right so if you if you palpate a mass in

the femoral triangle

femoral hernia whereas the an inguinal hernia

hernia

will pass through the inguinal canal so

we'll be in a different place right so

the femoral canal and the femoral sheath

are relevant to a femoral hernia the

bowel pushing through that space um also

if you

want to access the heart

you could

put a wire a catheter a cannula whatever

into the femoral artery

that would then pass to the aorta so you

could access the aorta and the left side

of the heart or here you could put a

wire into

the femoral vein that would pass to the

inferior vena cava and you can access

the right side of the heart

these blood vessels are large

very superficial so they're pretty easy

to access

and you can then access

the thorax

also if you are assessing the blood flow

to the lower limb this is where you find

the femoral pulse

so these blood vessels are formed

passing through the femoral sheath the

femoral sheath is part of their function

so the femoral sheath is part of that

relevant and useful anatomy all right

there you go that's the anatomy of the

femoral sheath it's connective tissue

and we talked about the femoral canal

which is a space

and the femoral sheath has three spaces

in it and we looked at the blood vessels

and what have you and

we linked it up to other things nearby

that we might

confused with why have you got cobwebs

on you

um anyway see told you i couldn't talk about

about

it for that long the femoral sheath and

stuff in the femoral triangle femoral canal

canal

stop by see you next week [Music]

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