824 HUMAN ANATOMY. 



nervi ischiadici which loses, as a rule, its continuity with the popliteal. That artery now appears 

 to be the continuation of the saphenous (femoral), since there occurs a degeneration of the 

 saphenous below the point where the anastomosing branch is given off. These changes are 

 shown diagrammatically in Fig. 748, (page 849) from which it will be seen that the femoral artery 

 below the origin of the profunda is the upper part of the original a. saphena, the continuation of 

 that vessel down the crus being represented only by the superficial branch of the anastomotica 

 magna. 



The principal variations which are shown by the fernoral artery are associated with these 

 changes which it has passed through in its development, and represent a cessation of the devel- 

 opment at one stage or other of its progress. Thus, as already pointed out (page S15), the 

 comes nervi ischiadici may remain the principal vessel of the thigh, the femoral terminating in 

 the profunda femoris. Or the development may proceed to the formation of the a. saphena, 

 which may arise either immediately above the profunda femoris, in such case the superficial 

 femoral being wanting and the conies nervi ischiadici still well developed, or else from the lower 

 part of the femoral, just before it pierces the adductor muscle. From this point the vessel, 

 when fully developed, is continued onward with the long saphenous nerve between the adductor 

 magnus and the vastus medialis, and below the knee-joint perforates the crural fascia and is 

 continued superficially down the inner side of the crus, accompanying the long saphenous nerve 

 and vein to the internal malleolus, where it makes connections with the posterior tibial artery 

 and may sometimes persist as a branch of that vessel. 



In addition to these anomalies, the femoral artery frequently gives off branches which nor- 

 mally arise from other vessels. Thus it may give rise to the deep epigastric or the deep cir- 

 cumflex iliac, normally branches of the external iliac, or to the external or internal circumflex, 

 normally branches of the profunda femoris. It has also been observed to give origin to the ilio- 

 lumbar artery. 



Practical Considerations. — The femoral artery is more often wounded than 

 the brachial on account of the position of its upper half — in Scarpa's triangle — on 

 the anterior surface of the limb, and of its relatively more intimate relation to the 

 bone at its lower end. In the latter region it has been opened by spicules of necrotic 

 bone. Next to the popliteal, it is more frequently the subject of aneurism than any 

 other external arterial trunk. On account of the close relation of the lymphatic 

 glands in and near the groin, the vessel has been opened by ulceration and sloughing 

 in bubo or in carcinoma, and has been involved in sarcomatous growths. The same 

 relation has caused the aneurism to be mistaken for a glandular abscess, an error 

 which has occurred oftener in connection with this vessel than with any other. 



Compressio7i of the femoral artery has yielded very satisfactory results in the 

 treatment of popliteal aneurism. The pressure is best applied in a direction backward 

 and outward just below the inferior edge of Poupart's ligament where the vessel can 

 be flattened against the brim of the pelvis — the upper margin of the acetabulum — 

 just outside the ilio-pectineal eminence, only a very thin portion of the ilio-psoas 

 muscle intervening. A little lower, a more fleshy portion of that muscle separates it 

 from the head of the femur, and yet lower the artery has back of it the still less 

 resistant mass of the pectineus and adductor brevis muscles, and more force will be 

 required to obliterate its lumen. At the apex of Scarpa's triangle the pressure must 

 be directed backward and somewhat more outward, and a little lower still more 

 directly outward, the artery at these places being compressed against the femur, the 

 vastus internus intervening. 



Extreme flexion of the thigh upon the trunk will occlude the femoral, and has 

 been used successfully in the cure of popliteal aneurism and for the temporary arrest 

 of hemorrhage. 



Ligation of the vessel maybe done: i. Between Poupart's ligament and the 

 origin of the profunda — the common femoral {vide supra). 2. At the apex of 

 Scarpa's triangle. 3. In Hunter's canal. 



I. The common femoral is rarely ligated except as a preliminary to some forms 

 of hip-joint amputations, or for the relief of hemorrhage. In aneurism of the upper 

 portion of the superficial femoral the external iliac is ordinarily preferred because of 

 (a) the possibility of a high origin of the profunda. The common femoral is normally 

 only about one and a half inches in length. If its bifurcation occurs above the usual 

 level — the most common variation — the ligature would be in dangerously close 

 proximity to so large a trunk, (b) The presence of a number of smaller branches — 

 the deep epigastric and deep circumflex iliac coming of^ immediately above Poupart's 

 ligament, the superficial epigastric, circumflex iliac, and external pudic, the deep 

 external pudic, and occasionally one of the circumflex arteries (especially the internal), 



