FEMORAL ARTERY. 



243 



At the termination of its third stage the 

 artery passes into the ham and there receives 

 the name of popliteal : it enters the popliteal 

 region through an elliptical aperture situate to 

 the inside of the femur at the junction of its 

 middle and inferior thirds, and upon a plane 

 with its posterior face, the longer diameter of 

 which corresponds to the course of the artery, 

 and which is circumscribed by the lower mar- 

 gin of the united tendons of the adductor 

 longus and the adductor inagnus above, by the 

 connection between the tendon of the adductor 

 magnus and that of the vastus internus below ; 

 by the tendon of the adductor magnus inter- 

 nally, and by that of the vastus internus exter- 

 nally : in passing through, the artery carries 

 with it a prolongation of the femoral sheath, by 

 which the popliteal vessels become invested 

 and connected. 



Varieties. The superficial femoral artery sel- 

 dom presents a variation from its accustomed dis- 

 position, so much so that it may almost be held to 

 be uniform in this respect : however two forms 

 of deviation have been observed, rare in occur- 

 rence, but of great importance in a practical 

 point of view. Two instances of the first ab- 

 normal arrangement are recorded, one of which 

 occurred to Sir Charles Bell, and has been pub- 

 lished by him in Anderson's Quarterly Journal 

 for the year 1826: the second is preserved in 

 the Museum of the College of Surgeons, and 

 has been described in the fourth volume of the 

 Dublin Hospital Reports by Dr. Houston, 

 Conservator to the Museum. In these cases 

 the femoral artery divided into two vessels of 

 nearly equal size, which pursued the usual 

 course of the artery side by side and very close 

 together, not, however, in contact, but contained 

 in distinct compartments of the sheath and 

 separated by a septum : hence the existence of 

 the second artery might in operation easily pass 

 unobserved, it not being brought into view by 

 opening the sheath of the other. One was 

 also larger than the other, and situate internal 

 and on a plane posterior to it. In Bell's case 

 the discovery was the consequence of the un- 

 fortunate event of an operation for popliteal 

 aneurism ; the operation was performed in the 

 middle third of the thigh. The pulsation of 

 the aneurism, which was arrested on the appli- 

 cation of the ligature, returned after an interval 

 of some seconds, and became nearly as distinct 

 as before : it ceased again upon the third day, 

 but the patient was carried off on the sixth day 

 by an erysipelatous inflammation of the thigh. 

 On examination after death, it was ascertained 

 that the disposition, which has been described, 

 was present, and that but one of the two vessels 

 had been tied. 



The second form of deviation is a high 

 bifurcation into the posterior tibial and peroneal 

 arteries : of this an instance* has been recorded 

 by Sandifort, in which the division took place 

 immediately below Poupart's ligament ; and 

 Portalf states that the crural artery has been 

 seen to divide into two large branches shortly 



* Green on the Varieties in the Arterial System, 

 and Sandifort, Observ. Anat. Pathol. iv. 97. 

 t Anatomie Medicale, t. iii. p. 326. 



after its escape from the abdomen, and then 

 there were two popliteal arteries: he further 

 states that among individuals, in which the 

 brachial artery was bifurcated higher than usual, 

 the crural artery was so also in a remarkable 

 proportion.* 



A division of the femoral artery into two 

 trunks of equal size, running parallel and so 

 near together, that they might be conveniently 

 included in one ligature, is recorded by Gooch 

 in the Philosophical Transactions for the year 

 1775, it being the third instance in amputations 

 of the thigh, in which he had observed such a 

 lusus nature in the arterial system ; but it is 

 not mentioned whether they were instances of 

 the first or of the second kind of variety : he 

 himself, whether from examination or from in- 

 ference, appears to have concluded that both 

 trunks were prolonged into the lower part of 

 the limb. 



Those deviations have been accounted repe- 

 titions of similar irregularities in the brachial 

 artery, than which, however, they are far less 

 frequent. It is a matter to be regretted that 

 neither in the case of Bell, nor in that of 

 Houston, has any account been given of the 

 disposition of the artery of the upper extremi- 

 ties or of the other thigh. 



Branches of the femoral artery. The 

 branches given off by the femoral artery are 

 numerous ; but the trunk of the vessel being 

 itself intended for the supply of the leg and 

 foot, the branches which it gives to the thigh 

 are, with the exception of one intended speci- 

 ally for the nutrition of that part, inconsider- 

 able in size. The artery gives branches to the 

 integuments of the abdomen, to the glands and 

 other structures in the groin, to the external 

 organs of generation, to the muscles in the 

 vicinity of which it passes, to the inner side of 

 the knee ; and, lastly, it gives the large branch, 

 adverted to, for the supply of the thigh, and by 

 which those inosculations with other arteries 

 are formed, by means of which chiefly an in- 

 terruption in the course of the main vessel is 

 compensated. Those which have received 

 names are five, viz. \. the superficial epigas- 

 tric ; 2. the superficial or external pudic ; 3. 

 the superficial anterior iliac; 4. the profunda; 

 and 5. the superficial superior internal articular 

 arteries. 



Of those the first four arise from the artery 

 within its first stage ; the epigastric, iliac, and 

 pudic being given off immediately or at a very 

 short distance below Poupart's ligament; and 

 the profunda at a greater although a variable 

 distance from that part. 



1 . The superficial epigastric artery (artere 

 sous-cutanie abdominale, Cloquet ; inguinale, 

 Chaussier;) ordinarily arises from the front of 

 the femoral, immediately below Poupart's liga- 

 ment. Sometimes it is given off from a branch 

 common to it and either one or both the ex- 

 ternal pudics ; or it may proceed from the pro- 

 funda.f It first comes forward through the 

 fascia lata, and then ascends over Poupart's 



* Ibid. p. 239. 

 t Boyer. 



R 2 



