250 



FEMORAL ARTERY. 



at present unnecessary to insist upon it. But 

 the channels through which the circulation of 

 the blood becomes in such cases restored, as 

 well as the relations of the new circulation, are 

 deserving of attention. 



The collateral connections of the femoral 

 artery are distinguishable into those between it 

 and the arteries of the trunk, those between it 

 and the popliteal and arteries of the leg, and 

 those between different parts of its own course. 



The communication of the femoral artery 

 with the arteries of the trunk are established 

 between it and both the internal and the external 

 iliacs. 



Those with the internal iliac are formed, 1. 

 by means of the inosculations of the branches 

 of the profunda, the circumflex and perforating 

 arteries with the obturator, glutceal, and sciatic 

 arteries, all branches of the latter; 2. by those 

 between the internal and external pudics ; and, 

 3. by the communications of the ilio-lumbar 

 artery with the deep anterior iliac, by which the 

 blood may be transferred to the superficial an- 

 terior iliac or the external circumflex. 



From the obturator artery the blood is transmit- 

 ted through theascending branches of the internal 

 circumflex : this channel of communication be- 

 comes, in cases of interruption of the external 

 iliac artery, remarkably free, the branches esta- 

 blishing it being much enlarged and tortuous : 

 instances and representations of it may be 

 found in the Medico-Chirurgical Transactions, 

 vol. iv. and in Guy's Hospital Reports, INo. 1, 

 Jan. 1836, from the experience of Sir Astley 

 Cooper. 



Through the glutceal artery the femoral com- 

 municates with the internal iliac by the inoscu- 

 lations between that vessel, the posterior tro- 

 chanteric and the ascending terminal branches 

 of the internal circumflex, and by those between 

 it and the ascending and circumflex branches 

 of the external circumflex artery : those connec- 

 tions are displayed also in the works just 

 referred to. 



The communicalion of the femoral with the 

 internal iliac through the sciatic artery is esta- 

 blished by the anastomosis of that vessel with 

 the internal circumflex and the perforating arte- 

 ries, for which also see the same works. 



The alteration in the condition of the sciatic 

 artery or its branches caused by ligature of the 

 femoral or of the external iliac artery presents 

 one of the most remarkable results of that cir- 

 cumstance : its branch to the sciatic nerve be- 

 comes greatly enlarged, very tortuous, and so 

 much elongated as to form at times a commu- 

 nication between the sciatic artery and the 

 posterior tibial. The connections established 

 through the pudic and ilio-lumbar arteries are 

 set forth, in the event of a case of ligature of the 

 external iliac artery published in the Medico- 

 Chirurgical Transactions, vol. xx. by Mr. 

 Norman. 



The femoral artery communicates with the 

 external iliac through means of the anastomoses 

 between the anterior iliac arteries, internal and 

 external, between the internal anterior iliac and 

 the external circumflex ; and also by those be- 

 tween the superficial and internal epigastrics. 



By the communications, which have been 

 mentioned, the transmission of blood through 

 the femoral artery may be restored, after the 

 interruption of the external iliac artery, or of 

 the femoral above the origin of the profunda, 

 with sufficient freedom for the perfect nutrition 

 of the limb ; of which numerous instances have 

 been observed by different writers. 



The upper and lower parts of the femoral 

 artery are also connected by collateral channels. 

 Those are established by the communications 

 which exist between the branches of the pro- 

 funda artery arising from the upper extremity 

 of the femoral, and branches of the latter given 

 off during its course or from its lower extre- 

 mity ; thus the blood may pass from the femo- 

 ral artery above into the middle part of the 

 vessel through the anastomosis existing between 

 the descending branches of the external circum- 

 flex artery, and the branches given by the femo- 

 ral to the vastus internus muscle about the 

 middle of the thigh. 



A similar communication exists upon the 

 internal side of the femoral by means of the 

 anastomoses by which descending branches of 

 the internal circumflex are connected with those 

 given by the femoral itself to the adductors. 



The collateral connection of the femoral with 

 the popliteal artery is established through two 

 channels: 1. through the anastomoses between 

 the branches of the profunda, as well the ex- 

 ternal circumflex as the perforating arteries, 

 with the branches of the popliteal; whence 

 the femoral may be interrupted at any part 

 below the origin of the profunda, and the 

 blood thus find a ready passage from it into 

 the popliteal : 2. through those of the branches 

 given by the femoral to the vastus internus and 

 the superficial superior internal articular with 

 the same. 



To the channels of communication which 

 have been described are to be added, as 

 pointed out by Scarpa, those established, by 

 the arteries of the periosteum and of the in- 

 ternal structure of the femur, between the 

 main arteries above and below. The former 

 are well represented by Scarpa,* and are formed 

 by anastomoses between branches of the external 

 circumflex, the profunda, the femoral and the 

 popliteal distributed to the periosteum. 



Upon a review of the anastomotic con- 

 nections of the femoral artery, its course pre- 

 sents two stations at which communications 

 are established, on the one hand with the 

 main artery above, and on the other with that 

 below, while in the interval they are connected 

 the one with the other. Those are, 1. the first 

 part of the vessel's course from its commence- 

 ment to below the origin of the profunda ; 

 and, 2. its lower part for so much of it as 

 includes the origins of the branches to the 

 triceps crural and adductor muscles, and the 

 superficial superior internal articular. 



Again, it appears that through the first 

 station, not only is the femoral connected with 

 the arteries of the trunk and with the lower 

 part of the vessel, but also it is connected 



* Reflexions sur 1'Aneurisme, tab. ii. 



