440 ARTERIES. 



on the outer side of the artery, in close apposition with it, and, still more ex. 

 ternally, is the internal or long saphenous nerve. 



Relations. From above downwards, the femoral artery rests upon the Psoas 

 muscle, which separates it from the margin of the pelvis and capsular ligament 

 of the hip; it is next separated from the Pectineus by the profunda vessels and 

 femoral vein ; it then lies upon the Adductor longus ; and lastly, upon the tendon 

 of the Adductor magnus, the femoral vein being interposed. To its inner side, 

 it is in relation, above, with the femoral vein, and, lower down, with the Ad- 

 ductor longus and Sartorius. To its outer side, the Yastus internus separates it 

 from the femur, in the lower part of its course. 



The femoral vein, at Poupart's ligament, lies close to the inner side of the artery, 

 separated from it by a thin fibrous partition, but, as it descends, gets behind it, 

 and then to its outer side. 



The internal saphenous nerve is situated on the outer side of the artery, in 

 the middle third of the thigh, beneath the aponeurotic covering, but not within 

 the sheath of the vessels. Small cutaneous nerves cross the front of the 

 sheath. 



Peculiarities. Double femoral reunited. Four cases are at present 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 magnus, so as to form a single popliteal artery. One of them 

 occurred in a patient operated upon for popliteal aneurism. 



Change of Position. A similar number of 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, escaping 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. 



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 for 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 and two inches below Poupart's liga- 

 ment ; 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. 



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

 putations or other operations on the lower limb, is most effectually made immediately below 

 Poupart's ligament. In this situation, the artery is very superficial, and is merely separated 

 from the margin of the acetabulum and front of the head of the femur, by the Psoas muscle ; so 

 that the surgeon, by means of his thumb, or any other resisting body 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 outwards, so as to compress the vessel on the inner side of the shaft of the femur. 



The application of a ligature to the femoral artery may be required in 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 in the lower part of its course, 

 its close connection with important structures, and the density of its sheath, render the operation 

 in this situation one of much greater difficulty than the application of a ligature at its upper 

 part, where it is more superficial. 



Ligation of the femoral artery, within two inches of its origin, is usually considered very unsafe, 

 on account of the connection of large branches with it, the epigastric and circumflex iliac arising 

 just above its origin; the profunda, from one to two inches below; occasionally, also, one of the 

 circumflex arteries arises from the vessel in the interspace between these. The profunda some- 

 times 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 situa- 

 tion for the application of a ligature to this vessel 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 posi- 

 tion, 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 fascia lata having 



