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Arteries of the lower limb

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This content details the arterial supply to the lower limb, tracing the path of major arteries from the aorta down to the foot, highlighting name changes, branching patterns, and the importance of collateral circulation around joints.

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[Music]

hello well that was nice wasn't it it's

now chucking it down with rain so I

thought I'd record another little

video um hoping the rain will stop

typical Welsh weather from Sun to rain

and you know

um everything else in between last week

we were talking about the arterial

supply to the Upper Limb so I thought

hey the obvious thing to talk about this

week would be the arterial supplies to

[Music]

right um so we're going to start off

with this guy like we did last time we

started with the aorta and followed the

arteries all the way out to the hand

we'll start with the aorta here and then

we'll uh we'll mostly work our way

through the lower limb right and we'll

see a lot of the same sort of themes

that we were talking about in the Upper

Limb being played out again in the lower

limb but we'll follow the archeries down

okay let's have a look at you then uh

I'll pick this model cuz hopefully it's

going to be fairly easy to take apart

I'm still take all this out okay so

we're taking out the GI

got a auto stops that's no good is it

right I get a different model then all

right let's try this [Applause]

[Applause]

one take out the G trct and T that's [Applause]

[Applause]

better so this is what we came for right

here's the

aorta all right so we're descending

within the abdomen really really deep

there's the aorta we're at the level

here there's the inferior meic artery

these are the gal arteries coming out of

it here and the aorta Ends by splitting

into the two common iliac arteries so we

have a left and right common iliac

artery if we were to follow the left

common iliac artery we see it dividing

again you see

that so we see an an internal iliac

artery which goes into the pelvis and is

going to supply blood to most of the

viscera of the pelvis and then we have

an external iliac artery running out

here we can see this is a um seos soos

major and Ilia soos that's forming so

it's lying on top of sois major so

that's the external iliac artery and

that's running down towards the lower

limb so that's what we're going to

follow remember there is no iliac artery

there are common iliac arteries and

external iliac arteries and internal ilc

arteries but there isn't an iliac artery

on its own always use the correct

terminology so all right moving on from

this one then okay so now we want to

look at the Upper Limb we can see

there's the common iliac artery there

and there's the internal iliac artery

going into the pelvis here and there's

the external iliac artery here okay so

now do you remember this so this here is

the ingin or ligament and when we

looking at the Upper Limb we saw how the

major artery as it as it passed into the

through the shoulder and through the

axilar and into the Upper Limb we

changed it name a number of times and

the same thing happens in the lower limb

so this external iliac artery when it

goes beneath the ingal ligament here we

change its name and it becomes the

femoral artery because it's moving into

the thigh so femoral of the thigh so

this now becomes the artery of the thigh

so it's the same blood vessel look but

it's just changing its name from

external iliac artery to femoral artery

and the femoral artery then is moving

into the anterior compartment of the thigh

um do you remember how we've got an

anterior compartment with quadriceps in

it and a medial compartment with the

adductors in it and we have a posterior

compartment with the hamstrings in it

right so go and have a look at the

muscles of the hip uh and the lower limb

um but these muscles are grouped

together and they're kept in separate

compartments by connective tissue so

this sometimes gets called the common

femoral artery but the femoral artery

moves into the anterior compartment

let's dissect away some of these muscles

see if we can see where it goes so this

is sorus cutting across here let's take sorus

off come um now we can see a lot more so

this artery then is is running deep to

sorus it's running in this subsartorial

canal and we can see that it's running

with a vein and a nerve that's the

femoral vein and the femoral nerve that

it's running with but can you see

how it's it's not just descending

through the anterior compartment but

it's running around here immediately

towards the adductor compartment towards

the medial compartment and it gives off

a deep Branch oh we can see that up here

so these are the Deep branches of the

femoral artery here uh profund femoris

so these are going into the the muscle

mass and they're going to supply blood

to the femur and to the the quadriceps

femoris muscle groups and all the other

muscles in here if we were to take away

there we go we can see some more

branches if we take off uh rectus

femoris here

but if we keep following our main

target um the feminal artery what it's

the squeaky it's trying to get into the

back of the knee into the poal fucer so

to do that um it needs to get

through the abductor muscles now what

can we see so we've got a whole bunch of

adductor muscles we've got a gillus and

adductor longus and adductor Magnus and

and all sorts and they're coming

together here and they're they're

meeting this is the there's the big toe

here this is the medial side of the knee

they're coming together to meet

semimembranosus and

semitendinosis the medial hamstring

muscles around here so we can't see too

much on this model it's getting messy

but what it's getting covered up by muscle

muscle

bulk but what we find if we look in that

adductor group is there's an adductor

Hiatus there's a gap in the muscular

attachment of the adductors to the femur

and the femoral artery goes through that

adductor Hiatus through that Gap as it

winds around and in doing so that's what

enables it to get to the poal region to

the poal fucer so when it passes through

the adductor Hiatus the femoral artery

changes its name and it becomes the popal

popal

artery so from the femoral artery up

here there are lateral and

medial circumflex femoral arteries and

those loop around the

femur um and there are also circumflex

arteries coming from the external iliac

artery up on the other side of the hip

and we see these blood vessels branches

of these blood vessels meeting and

anastomosing so we have these

anastomoses Across The Joint so this is

another example of collateral

circulation in the limb just as we see

in the Upper Limb we see collateral

circulation around each joint so around

the hip um what this means is that if

this artery was to get uded for whatever

reason there's an alternate rout of

which blood can flow around the joint to

continue to get into the limb so the

tissues of the limb won't become

ischemic common theme throughout the

limbs at all the joints as we see as we

go down so at the knee we also see we

can see some blood vessels here

superficially we also see a whole bunch

of branches so if we think about it

we've got this single popal artery

descending through the poal region

passing through the knee and it sends

off a whole bunch of branches to supply

the structures of the knee and also to

set up potential collateral circulations

uh there are anastomosis so these are so

the the Latin word for knee is genu um

which has come up before in my videos we

see knee shaped things they get called

geniculate right um or genu something or

other so these arteries

arteries

at the knee these branches of the popal

artery get called geniculate arteries we

have uh lateral Superior lateral

inferior medial Superior medial inferior

and medial genicular arteries and look

we can see these okay so let's uh take

hamstrings there we go now you can see

here look there's the femoral artery

passing through through that adductor

Hiatus that Gap in the adductor muscles

so we change its name now and we're

going to call it the popal artery poal

arter is descending through the poal

fosser and look we can see some branches

coming off here um and these are some of

the the genicular arteries like I say

they're a lot more than you can see on

this model so again we have Superior and

inferior medial and lateral so that's

four plus another medial or

middle geniculate artery so these occur

um proximal and distal to the knee joint

or you might say Superior and inferior

to the knee joint and they interconnect

with an asmosis so there's another

potential route for collateral

circulation to set up if the poar gets

occluded and if you think about it just

by keeping the knee flexed for a long

period of time um will you might need

that might be enough for blood to flow

through the collateral circulation to

get the distal in just cuz the pop AR is

going to get compressed somewhat easily

then maybe

maybe so the potin artery passes through

the poal fossa so we're descending down

and don't forget we call this the thigh

between the hip and the knee and then

distal to the knee we call that the leg

so we're descending into the leg or

we're descending into the calf you might

say and this is gastrus we take off

gastrus now what we should

see oh look we can see some more

genicular branches

here what we should see is the poal

artery ends because it splits so it it

it becomes the posterior tibular artery

but it also gives off an anterior

tibular artery so what we see here

running down the Cal remember this is

deep to gastrus and cus because I've

taken those guys off so the artery is

quite deep now um this is the posterior

tibial artery here so if this is the

posterior tibial

artery the anterior tibal artery needs

to get to the anterior compartment so

again in the calf we have a number of

compartments we have this posterior

compartment and an anterior compartment

and they're separated by the tibia and

the fibula and in between the tibia and

the fibula there's a membrane an interus

membrane just like we see in the forearm

interus so yeah it's a connective tissue

sheet in between the two bones so an

interus membrane so this means that the

anterior tibial artery has to pass

through the interus membrane to get to

the anterior compartment now we can't

see that happening there it'll be going

through there somewhere so if we turn

this around what can we see right if we

take away if we dissect away these

muscles a bit a there we

go yeah there it is so there's the

anterior tibial artery there so it's

pasted through and we can see there so

there's the fibula this is the this is lateral

lateral

right there's the little toe there's the

big toe there's the little toe so this

medial so this is the fibula around here

this is the tibia and you can see look

there's that interus membrane in between

the two so the anterior tibial artery

has passed through the osus membrane and

look it's running down on the interus membrane

membrane

anteriorly to supply blood to the

anterior compartment muscles and

leg there's another artery as well

there's a fibular artery so the

posterior tibal artery gives off a

fibular branch which runs down with the

fibula supplying blood to the Bone

itself and to other structures nearby

nearby um

so I'm not entirely sure what that would

be up here on this model but we can see

it just down here there's the fibular artery

there and around the so if this is the

head of the fibula around the neck of

the fibula we'd also expect to see

another circumflex fibular artery

surrounding it up there and that also

May well have connections with the other

branches around the the knee up here

there might be other

anastomoses okay so if we follow the

posterior tibial artery let me get rid

of this there's the big toe there right

so this is

medial so there's the posterior tibular

artery and look it's running medly and

it's going to run into the what's going

to fall off this I it's going to run

into the foot and I'll grab a foot model

to look at that in more detail but we've

got these two bony bits here right so if

I turn it around so

look there's the big toe there's the

little toe we got these two bony bits

and these two bony bits are things you

can palpate these are the the

malleoli um remember the the fibula is

lateral so this is the lateral malleolus

of the

fibula and this is the medial malleolus

of the

tibia and the posterior tibial artery is

going to run

around the medial malas to get into the

foot and the fibular artery is in there

uh um and that's running around the the

lateral malleolus right whereas if we look

look

anteriorly look there's the anterior

tibial artery and as it descends it's

going into the dorsum of the foot this

is the dorsal surface this is the

planter surface that you stand on so the

anterior tibial arter is actually going

to become the dorsales pedis

pedis

um which is kind of hidden here but it's

it's about there right let's let's swap

to the foot model at this

point right now oh that's nice

look there's

the posterior tibular artery there's the

big toe so this is medial this is the medial

medial

malleolus and look how the posterior tibial

tibial

artery is curling around to get into the

foot so it's the posterior tibial artery

then that's going to supply blood to the

planter foot and I'm gonna have to

disect quite a lot

here there's a lot of layers on this model

um okay that's not too bad so you can see

see

here there's the big toe right there's

the big to this is medial so the

posterior tibial artery ends as the

medial planter artery and the lateral

planter artery and these guys go into

the foot if I I'm going to take that

off I'm going to take that [Applause]

off all right so I'm just going to take

this layer away oh there's another layer

of muscle there I'm going to take oh got

to take that off got to take that off

what I'm getting down

to is another look another Arch another

AR arterial arcade here so essentially

the the Deep

um the the lateral and medial planter

arteries and the Deep planter artery

they're coming together to form um a

deep planter Arch um as we saw in the

hand we saw superficial and deep planter

superficial and deep Palmer arches in

the hand didn't we there's a planter

Arch here now I read that there is

sometimes superficial and deep planter

arches sometimes there's just a single

planter Arch and it just gets called the

planter Arch and sometimes gets called

The Deep planter

Arch um so watch out for that and then

this planter Arch is giving off a whole

bunch of uh metatarsal and digital

branches to supply the toes and the

metat tassels and stuff like that right

so that's how the posterior tibial artery

artery

ends flip it over

over

and oh I've got so many bits all right

so here is the the anterior tibal artery

here where the anterior tibal artery

passes between the two malleoli we

change its name to as I said dorsalis

pedis and this is where you can feel the

pulse we'll talk about pulses in a

moment but dorsales pedis passes down

here oh that's cool and it gives off

look this this artery here can you see

that that's disappearing down through a

hole so that's running

between the meta met tarsals the first

and second metatarsal and that that is

the Deep planter artery that I was on

about so that dives down through the

foot to join with this Arch so this Arch

is is actually supplied with blood by

the lateral and medial planter

arteries and dorsales pedis so it's a

receive it's receiving blood from both

the anterior and the posterior tibular

arteries cool huh so there are clear

anastomoses across the ankle and across

the foot as well

right the fibular artery Ends by giving

off we just about to see it in there if

I take this

there in there so that's the lateral

malleolus there It Ends by giving off

look there's a calcal branch back here

and malola

branches so the fibular artery which is

appearing here then

um so it's giving off this Branch to the

calcal bones this calcal branch is

giving off this lateral malola Branch

but look it's got to pass through the

interos the interus membrane to get out

here now something we can't see on

here is deep to these

muscles there's another arcade or kind

of dorsalis pedis once it gives off this

deep planter artery here it also well

you see it also gives off these other

branches to the toes but it continues

around like this right doesn't go all

the way around here just imagine a short

bit right like

that and that would be the rq8 artery so

we've got another Arch on this side as

well kind of and sometimes this also

anastomoses with branches from the

fibular artery and sometimes it just it

doesn't it just get off a whole bunch of

branches and ends so if we could see it

underneath those muscles we might find

the aru artery curving around like that

so it does get a lot more complicated

when you get down to the foot and the

ankle but the lower limb otherwise is

fairly straightforward when you get down

to the foot and the ankle if you know

the names of the bones of the foot and

the ankle then the arteries nearby are

much easier to name and recognize why

they follow the name of the bones

basically to learn the bones of the f

um now there are a number of places in

the lower limb where you would like to

be able to um palpate the pulse to

assess blood flow to the lower limb so

we need to have a look and see where

this the these arteries are superficial

so you can palpate them so let me put

this back [Applause]

together all right let's put back on

what can we palpate

well superior to the ingon or ligament

we're covered in um abdominal

musculature here aren't we so it might

be difficult to palpate that but here

this looks pretty superficial so here

just inferior to the ingon or ligament

you should be able to palpate your

femoral pulse you might want to try that

now unless you're in public somewhere in

which case keep R out your trasers um

but that's the femoral pulse there and

then of course it's deep to muscle until

we turn around to the poil fosser but

this is again superficial so you should

be able to find a pole pulse in there

you might want to try to find that if

you've got shorts on um or a skirt

there's the poal pulse and then the

muscles are deeper the arteries are deep

to muscles again aren't they um until we

get down towards the ankle and then down

here so we find there's the big toe so

find the medial malleolus and then

here you should be able to palpate the

pulse of the posterior tibular artery

try that and

then on the dorsum of the foot this

muscle is pretty thin here you should be

able to find around here somewhere the

pulse of the dorsalis pedis artery so

you can then work your way through the

lower limb and assess um the blood

supply to the lower limb by palpating

the pulse all right okay there you go go

the arterial supply to the lower limb

again um we're following a single artery

largely that's changing its name as we

go through the limb we find lots of

branches at the joints um and then

asmosis so the potential for a

collateral circulation around the hip

joint the knee joint and the ankle joint

just as we see in the Upper Limb and

then as we get into the foot we also see

those arteries often linking up um and

the blood supply when we get into the

foot gets pretty complicated the

important parts are the um medial and

lateral planter arteries and dorsalis

pedis and then some of the other

branches that are linking things up all

right well done

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YouTube Transcript:Arteries of the lower limb