THE ANTERIOR TIBIAL ARTERY 



posterior, and through the aperture above the upper border of the interosseous 

 membrane, to the deep part of the front of the leg: it here lies close to the medial 

 side of the neck of the fibula. It then descends on the anterior surface of the inter- 

 osseous membrane, gradually approaching the tibia; at the lower part of the leg 

 it lies on this bone, and then on the front of the ankle-joint, where it is more 

 superficial, and becomes the dorsalis pedis. 



Relations. In the upper two-thirds of its extent, the anterior tibia! artery rests upon the inter- 

 osseous membrane; in the lower third, upon the front of the tibia, and the anterior ligament of 

 the ankle-joint. In the upper third of its course, it lies between the Tibialis anterior and Extensor 

 digitorum longus; in the middle third between the Tibialis anterior and Extensor hallucis longus. 

 At the ankle it is crossed from the lateral to the medial side by the tendon of the Extensor hallucis 

 longus, and lies between it and the first tendon of the Extensor digitorum longus. It is covered 

 in the upper two-thirds of its course, by the muscles which lie on either side of it, and by the deep 

 fascia; in the lower third, by the integument and fascia, and the transverse and cruciate crural 

 ligaments. 



The anterior tibial artery is accompanied by a pair of venae comitantes which lie one on either 

 side of the artery; the deep peroneal nerve, coursing around the lateral side of the neck of the 

 fibula, comes into relation with the lateral side of the artery shortly after it has reached the 

 front of the leg; about the middle of the leg the nerve is in front of the artery; at the lower part 

 it is generally again on the lateral side. 



Peculiarities in Size. This vessel may be diminished in size, may be deficient to a greater 

 or less extent, or may be entirely wanting, its place being supplied by perforating branches from 

 the posterior tibial, or by the perforating branch of the peroneal artery. 



Course. The artery occasionally deviates toward the fibular side of the leg, regaining its 

 usual position at the front of the ankle. In rare instances the vessel has been found to approach 

 the surface in the middle of the leg, being covered merely by the integument and fascia below 

 that point. 



Branches. The branches of the anterior tibial artery are: 



Posterior Tibial Recurrent. Muscular. 



Fibular. Anterior Medial Malleolar. 



Anterior Tibial Recurrent. Anterior Lateral Malleolar. 



The posterior tibial recurrent artery (a. recurrens tibialis posterior) an inconstant 

 branch, is given off from the anterior tibial before that vessel passes through the 

 interosseous space. It ascends in front of the Popliteus, which it supplies, and 

 anastomoses with the inferior genicular branches of the popliteal artery, giving 

 an offset to the tibiofibular joint. 



The fibular artery is sometimes derived from the anterior tibial, sometimes irom 

 the posterior tibial. It passes lateralward, around the neck of the fibula, through 

 the Soleus, which it supplies, and ends in the substance of the Peroneus longus. 



The anterior tibial recurrent artery (a, recurrens tibialis anterior) arises from 

 the anterior tibial, as soon as that vessel has passed through the interosseous 

 space; it ascends in the Tibialis anterior, ramifies on the front and sides of the 

 knee-joint, and assists in the formation of the patellar plexus by anastomosing 

 with the genicular branches of the popliteal, and with the highest genicular artery. 



The muscular branches (rami musculares) are numerous; they are distributed to 

 the muscles which lie on either side of the vessel, some piercing the deep fascia to 

 supply the integument, others passing through the interosseous membrane, and 

 anastomosing with branches of the posterior tibial and peroneal arteries. 



The anterior medial malleolar artery (a. malleolaris anterior mediates; internal 

 malleolar artery) arises about 5 cm. above the ankle-joint, and passes behind the 

 tendons of the Extensor hallucis longus and Tibialis anterior, to the medial side of 

 the ankle, upon which it ramifies, anastomosing with branches of the posterior tibial 

 and medial plantar arteries and with the medial calcaneal from the posterior tibial. 



The anterior lateral malleolar artery (a. malleolaris anterior lateralis; exter- 

 nal malleolar artery) passes beneath the tendons of the Extensor digitorum 



