THE FEMORAL ARTERY. 633 



middle third of the thigh, beneath the aponeurotic covering of Hunter's canal, but 

 nut usually within the sheath of the vessels. The internal cutaneous nerve passes 

 obliquely across the upper part of the sheath of the femoral artery. 



Peculiarities. Double Femoral reunited. Several cases are recorded in which the femoral 

 artery divided into two trunks below the origin of the profunda, and became reunited near the 

 opening in the Adductor niagnus so as to form a single popliteal artery. One of them occurred 

 in a patient operated upon for popliteal aneurism. 



Change of Position. A tew 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, 



ing 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. The 



external iliac in these cases was small, and terminated in the profunda. 



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

 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 fur 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 

 ligament ; 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. 



Surface Marking. The upper two-thirds of a line drawn from a point midway between 

 the anterior superior spine of the ilium and the symphysis pubis to the prominent tuberosity on 

 the inner condyle of the femur, with the thigh abducted and rotated outward, will indicate the 

 course of the femoral artery. 



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

 amputations and other operations on the lower limb, and also for the cure of popliteal aneurisms, 

 is most effectually made immediately below Poupart's ligament. In this situation the artery is 

 very superficial, and is merely separated from the horizontal ramus of the os pubis by the Psoas 

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

 circulation 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 outward, so as to compress the vessel against the inner side of the shaft of the femur. 



The application of a ligature to the femoral artery may be required in the 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 opera- 

 tion 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 common femoral artery is usually considered unsafe, on account of the con- 

 nection of larse branches with it viz. the deep epigastric and the deep circumflex iliac arising 

 just above Poupart's ligament ; on account of the number of small branches which arise from 

 it in its short course : and on account of the uncertainty of the origin of the profunda femoris, 

 which, if it arise high up. would be too close to the ligature for the formation of a firm coagu- 

 lum. 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, passing in the course of the artery to join the saphena: this must be avoided, and, 

 the fas -ia lata having been cautiously divided and the Sartorius exposed, that muscle must be 

 drawn outward in 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 opened on the outer 

 side of the vessel to a sufficient extent to allow of the introduction of the ligature, but no farther ; 

 otherwise the nutrition of the coats of the vessel may be interfered with, or muscular branches 

 which arise from the vessel at irregular intervals may be divided. In this part of the operation 

 the long saphenous nerve and the nerve to the Yastus internus. which is in close relation with 

 the sheath, should be avoided. The aneurism needle must be carefully introduced and kept 

 close to the artery, to avoid the femoral vein, which lies behind the vessel in this part of its 

 course. 



To expose the artery, in Hunter's canal, an incision should be made through the integument, 

 between three and four inches in length, a finger's breadth internal to the line of the artery, in 

 the middle of the thigh i. c. midway between the groin and the knee. The fascia lata having 

 been divided and the Sartorius muscle exposed, it should be drawn inward, when the stronir 



1 Ligature of the femoral artery has been also recommended and performed for elephantiasis of 

 the leg and acute inflammation of the knee-joint (Maunder, Clin. Soc. Trans., vol. ii. p. 37). 



