520 ARTERIES. 



PLAN OF THE KELATIONS OF THE FEMORAL ARTEKY. 



In front. 

 Fascia lata. 



Branch of anterior crural nerve. 

 Sartorius. 



Long saphenous nerve. 

 Aponeurotic covering of Hunter's canal. 



Inner side. / ^V Outer side. 



Femoral vein (at upper part) 1 Femoral \ Vastus Internns. 



Abductor Longus. 1 Artery. I Femoral vein (at lower part). 



Sartorius. V / 



Behind. 

 Psoas muscle. 

 Profunda vein. 



. Pectineus muscle. 



Adductor Longus. 

 Femoral vein. 

 Adductor Magnus. 



Peculiarities. Double femoral re-united. Four cases are at present recorded, in which the 

 femoral artery divided into two trunks below the origin of the profunda, and became re-united 

 near the opening in the Adductor Magnus, so as to form a single popliteal artery. One of them 

 occurred in a patient operated upon for popliteal aneurism. 



Change of Position. A similar number of cases have been recorded, in which the femoral 

 artery was situated at the back of the thigh, the vessel being continuous above with the internal 

 iliac, escaping from the pelvis through the great sacro-sciatic foramen, and accompanying the 

 great sciatic nerve to the popliteal space, where its division occurred in the usual manner. 



Position of the Vein. The femoral vein is occasionally placed along the inner side of tho 

 artery, throughout the entire extent of Scarpa's triangle ; or it may be slit, so that a large vein 

 is placed on each side of the artery for a greater or less extent. 



Origin of the Profunda. This vessel occasionally arises from the inner side, and more rarely, 

 from the back of the common trunk ; but the more important peculiarity, in a surgical point of 

 view, is that which relates to the height at which the vessel arises from the femoral. In three- 

 fourths of a large number of cases, it arose between one or two inches below Poupart's liga- 

 ment ; in a few cases, the distance was less than an inch ; more rarely, opposite the ligament ; 

 and in one case, above Poupart's ligament, from the external iliac. Occasionally, the distance 

 between the origin of the vessel and Poupart's ligament exceeds two inches, and in one case it 

 was found to be as much as four inches. 



Surgical Anatomy. Compression of the femoral artery, which is constantly requisite in am- 

 putations and other operations on the lower limb, is most effectually made immediately below 

 Poupart's ligament. In this situation the artery is very superficial, and is merely separated 

 from the margin of the acetabulum and front of the head of the femur, by the Psoas muscle ; 

 so that the surgeon, by means of his thumb, or a compressor, may effectually control the circu- 

 lation through it. This vessel may also be compressed in the middle third of the thigh, by 

 placing a compress over the artery, beneath the tourniquet, and directing the pressure from 

 within outwards, so as to compress the vessel on the inner side of the shaft of the femur. 



The application of a ligature to the femoral artery may be required in cases of wound or 

 aneurism of the arteries of the leg, of the popliteal or femoral ; and the vessel may be exposed 

 and tied in any part of its course. The great depth of this vessel at its lower part, its close 

 connection with important structures, and the density of its sheath, render the operation in this 

 situation one of much greater difficulty than the application of a ligature at its upper part, 

 where it is more superficial. 



Ligature of the femoral artery, within two inches of its origin, is usually considered unsafe, 

 on account of the connection of large branches with it, the epigastric and circumflex iliac aris- 

 ing just above its origin ; the profunda. from one to two inches below, occasionally, also, one of 

 the circumflex arteries arises from the vessel in the interspace between these. The profunda 

 sometimes arises higher than the point above mentioned, and rarely between two or three inches 

 (in one case four), below Poupart's ligament. It would appear, then, that the most favorable 

 situation for the application of a ligature to the femoral, is between four and five inches from its 

 point of origin In order to expose the artery in this situation, an incision, between two and 

 three inches long, should be made in the course of the vessel, the patient lying in the recumbent 

 position, with the limb slightly flexed and abducted. A large vein is frequently met with, pass- 

 ing in the course of the artery to join the saphena ; this must be avoided, and the fascia lata 

 having been cautiously divided, and the Sartorius exposed, that muscle must be drawn outwards. 

 \n order to fully expose the sheath of the vessels The finger being introduced into the wound, 

 and the pulsation of the artery felt, the sheath should be divided over the artery to a sufficient 

 extent to allow of the introduction of the ligature, but no further; otherwise the nutrition of 



