242 



FEMORAL ARTERY. 



from resting upon the psoas, while the vein 

 corresponds to the pubes between that muscle 

 and the pectinalis: hence the two vessels at 

 their entrance into the thigh, allowance being 

 made for the trifling difference which has been 

 mentioned, lie side by side, the vein internal 

 to the artery ; but as the former descends from 

 the pubes, it recedes from the surface more 

 than the artery, and at the same time inclines 

 out\v;ird, and thus it becomes posterior to it 

 at the lower part of the stage, so as to be con- 

 cealed by the artery by the time it has reached 

 its termination. It is included with the artery 

 in the femoral sheath, and is separated from it 

 by the external of the two septa, which have 

 been described. 



In its second stage the relations of the artery 

 differ considerably from those in its first. In 

 the first place it is covered throughout by the 

 sartorius, the muscle crossing it obliquely from 

 without inward, and thence first overlapping it 

 by its inner edge, and gradually extending over 

 it until the vessel is directly covered by it. 

 Secondly, it is in consequence covered by two 

 laminae of the fascia lata enclosing the muscle; 

 one superficial to it, the other beneath it, form- 

 ing the front of the femoral canal ; it has then 

 two new coverings, the muscle and the second 

 lamina of the fascia. Thirdly, the femoral vein, 

 which is very closely connected to the artery, 

 is directly behind it, between it and the adduc- 

 tor longus muscle, to which the artery corre- 

 sponds posteriorly. Fourthly, it has no part 

 deserving of attention upon its inside ; and, 

 lastly, the saphenus nerve is within the femoral 

 canal, along the outer side of the artery and 

 anterior to it. 



The inferior third of the artery also presents 

 some peculiarities of relation. The vessel is 

 still covered by the sartorius ; but here the 

 muscle is more to the inner, as in the second 

 stage it is more to the outer side of the vessel, 

 not only connecting it in front, but also lying 

 against its inner side, and the more so the 

 nearer we approach the termination of the 

 stage; so much so indeed, that at its termina- 

 tion, the artery, when injected, may be felt 

 beneath the outer margin of the muscle; and 

 hence the difference between the mode of pro- 

 ceeding with regard to the sartorius recom- 

 mended generally to be adopted, when occasion 

 arises for seeking the artery in its inferior third, 

 and that to be pursued when the vessel is to 

 be exposed in its second stage ; it being ad- 

 vised, in the latter case, to displace the inner 

 edge of the muscle outward, and in the former 

 the outer inward, in order to reach the vessel 

 with the greatest ease and certainty. The ves- 

 sel is also covered by the same two laminae of 

 the fascia; but the deep one presents at this 

 part remarkable features : it increases in thick- 

 ness and is more aponeurotic in proportion as 

 it descends, and hence it is stronger the nearer 

 we approach the termination of the course of 

 the artery ; but in the inferior third its thick- 

 ness is still further augmented by numerous 

 tendinous fibres, which pass from the tendons 

 of the adductors longus and magnus to that of 

 the vastus internus, add very much to the 



thickness of the fascia, and give to It the ap- 

 pearance of a tendinous expansion of great 

 strength, connecting the tendons of the mus- 

 cles, which have been mentioned, and covering 

 the artery upon its anterior and internal sides. 

 It is also to be observed that this accession of 

 fibres from the tendons exists only in the infe- 

 rior third of the artery's course, and not in its 

 middle stage, and hence the covering of the 

 vessel beneath the sartorius, or the anterior 

 wall of the canal, is much thicker and stronger 

 in the former than in the latter ; and hence 

 also one of the difficulties encountered in 

 getting at the vessel in the third stage. The 

 artery in this third stage is situate upon the 

 inside of the shaft of the femur, crossing it ob- 

 liquely from before backward : it is not, how- 

 ever, in contact with the bone, but is separated 

 from it by the vastus internus muscle : it is 

 enclosed, as before stated, between muscles ; 

 the sartorius before and internal to it, the ad- 

 ductors longus and magnus behind it, and the 

 vastus internus on its outside. 



The other relations of the vessel in this stage 

 are to the saphena vein, the saphenus nerve, 

 the femoral vein, and the superficial superior 

 internal articular artery. The first is situate 

 between the femoral artery and the internal 

 face of the thigh, for the most part along the 

 inner margin of the sartorius, but varying some- 

 what in this respect, lying at times upon the 

 muscle, from its middle to its inner edge, and 

 at others posterior to it. The saphenus nerve 

 is placed at first, as in the second stage, exter- 

 nal and anterior to the artery, but it crosses it 

 at its termination and escapes from the canal, 

 upon its inside, in company with the superficial 

 articular artery, as the vessel is about to pass 

 into the popliteal space. The femoral vein is 

 behind the artery and somewhat external to it : 

 the latter relation of the vein is expressly de- 

 nied by Velpeau,* but after careful examina- 

 tion the author does not hesitate to affirm it. 



The superficial superior internal articular 

 artery, a branch of the femoral, is given off by 

 the artery immediately before its termination ; 

 it arises from the front of the vessel, descends 

 nearly in the course of it, escapes from the 

 femoral canal in company with the saphenus 

 nerve, and, holding generally the same relation 

 to that nerve which the femoral itself does, may 

 hence be mistaken for that artery at the inferior 

 part of its course. 



Thus the relations of the vessel are here in 

 several particulars the reverse of those in its 

 former stages, and the methods most eligible 

 for adoption in operation ought to be varied 

 accordingly. Operation in its last stage is 

 seldom required, but it may be necessary, as 

 in wounds of the artery at that part, in which 

 case the mode of proceeding with regard to the 

 sartorius and to the artery should be the reverse 

 of that recommended for the upper stage, the 

 muscle being to be displaced inward in order 

 to expose the artery, and the separation of the 

 latter from the vein to be effected in the same 

 direction. 



* Anatpmie Jes Regions, t. ii. p. 485. ed. 1. 



