630 ANGIOLOGY 



from 2 to 5 cm. below the inguinal ligament. At first it lies lateral to the femoral 

 artery ; it then runs behind it and the femoral vein to the medial side of the femur, 

 and, passing downward behind the Adductor longus, ends at the lower third of the 

 thigh in a small branch, which pierces the Adductor magnus, and is distributed 

 on the back of the thigh to the hamstring muscles. The terminal part of the pro- 

 funda is sometimes named the fourth perforating artery. 



Relations. Behind it, from above downward, are the Iliacus, Pectineus, Adductor brevis, 

 and Adductor magnus. In front it is separated from the femoral artery by the femoral and pro- 

 funda veins above and by the Adductor longus below. Laterally, the origin of the Vastus medialis 

 intervenes between it and the femur. 



Peculiarities. This vessel sometimes arises from the medial side, and, more rarely, from the 

 back of the femoral artery; but a more important peculiarity, from a surgical point of view, is 

 that relating to the height at which the vessel arises. In three-fourths of a large number of cases 

 it arose from 2.25 to 5 cm. below the inguinal ligament; in a few cases the distance was less than 

 2.25 cm.; more rarely, opposite the ligament; and in one case above the inguinal ligament, from 

 the external iliac. Occasionally the distance between the origin of the vessel and the inguinal 

 ligament exceeds 5 cm. 



Branches. The profunda gives off the following branches: 



Lateral Femoral Circumflex. Perforating. 



Medial Femoral Circumflex. Muscular. 



The Lateral Femoral Circumflex Artery (a. circumflexa femoris later alls; external 

 circumflex artery) arises from the lateral side of the profunda, passes horizontally 

 between the divisions of the femoral nerve, and behind the Sartorius and Rectus 

 femoris, and divides into ascending, transverse, and descending branches. 



The ascending branch passes upward, beneath the Tensor fasciae lata?, to the 

 lateral aspect of the hip, and anastomoses with the terminal branches of the superior 

 gluteal and deep iliac circumflex arteries. 



The descending branch runs downward, behind the Rectus femoris, upon the 

 Vastus lateralis, to which it gives offsets; one long branch descends in the muscle 

 as far as the knee, and anastomoses with the superior lateral genicular branch of 

 the popliteal artery. It is accompanied by the branch of the femoral nerve to the 

 Vastus lateralis. 



The transverse branch, the smallest, passes lateralward over the Vastus inter- 

 medius, pierces the Vastus lateralis, and winds around the femur, just below the 

 greater trochanter, anastomosing on the back of the thigh with the medial femoral 

 circumflex, inferior gluteal, and first perforating arteries. 



The Medial Femoral Circumflex Artery (a. circumflexa femoris medialis; internal 

 circumflex artery) arises from the medial and posterior aspect of the profunda, 

 and winds around the medial side of the femur, passing first between the Pectineus 

 and Psoas major, and then between the Obturator externus and the Adductor 

 brevis. At the upper border of the Adductor brevis it gives off two branches: 

 one is distributed to the Adductores, the Gracilis, and Obturator externus, and 

 anastomoses with the obturator artery; the other descends beneath the Adductor 

 brevis, to supply it and the Adductor magnus; the continuation of the vessel 

 passes backward and divides into superficial, deep, and acetabular branches. The 

 superficial branch appears between the Quadratus femoris and upper border of the 

 Adductor magnus, and anastomoses with the inferior gluteal, lateral femoral 

 circumflex, and first perforating arteries (crucial anastomosis'). The deep branch 

 runs obliquely upward upon the tendon of the Obturator externus and in front 

 of the Quadratus femoris toward the trochanteric fossa, where it anastomoses 

 with twigs from the gluteal arteries. The acetabular branch arises opposite the 

 acetabular notch and enters the hip-joint beneath the transverse ligament in com- 

 pany with an articular branch from the obturator artery ; it supplies the fat in the 

 bottom of the acetabulum, and is continued along the round ligament to the head 

 of the femur. 



