FEMORAL ARTERY. 



247 



at times so many as five or six, and are dis- 

 tributed one or more to the rectus, entering 

 the muscle upon its deep surface, and pro- 

 longed to a great length within its substance ; 

 one to the vastus internus, one to the cruraeus, 

 and one or two to the vastus externus : they 

 are accompanied, several of them, by branches 

 of the crural nerve, and they run for a con- 

 siderable distance, particularly the infe- 

 rior branch to the vastus externus, between 

 the divisions of the triceps crural muscle, 

 before entering their substance : they are pro- 

 longed very low down, and may be followed 

 some of them to near the knee, where they 

 anastomose with branches of the femoral in 

 the vastus internus, and with the superior 

 articular arteries. But the branches of the 

 descending division of the external circum- 

 flex artery are by no means uniform in number 

 or destination, more or fewer of the arteries 

 just described being at times branches of the 

 profunda itself; thus, at times that to the 

 vastus internus, that to the cruraeus, and that 

 to the rectus, arise from the profunda below 

 the circumflex, and in such case the descend- 

 ing branch of the latter consists solely of the 

 branch or branches destined to the vastus ex- 

 ternus muscle. 



c. The third, the circumflex branch, pursues 

 at first the course of the original vessel, and 

 runs outward across the upper extremity of the 

 shaft of the femur below the great trochanter, 

 beneath the rectus and tensor vagina? muscles, 

 and superficial to the cruraeus. It gives, in 

 this situation, branches to the cruraeus, the 

 iliacus, the rectus and tensor muscles. It 

 then passes backward upon the outside of the 

 femur to its posterior part, and thus surrounds 

 the bone upon its anterior and external sides. 

 In the latter part of its course it traverses the 

 upper extremity of the vastus externus, and 

 gives off, 1. branches upward and downward 

 into the muscle; 2. a branch or branches which 

 run between the vastus and the bone, and 

 supply the periosteum ; 3. a branch to the 

 glutceus maximus at its insertion, which, after 

 furnishing it branches, perforates the muscle 

 and becomes superficial. The circumflex divi- 

 sion of the external circumflex anastomoses 

 with the internal circumflex, the glutceal, the 

 sciatic, and the perforating arteries. The ex- 

 ternal circumflex artery is accompanied by a 

 large vein, which crosses between the femoral 

 and profunda arteries, superficial to the latter, 

 in order to join the femoral or the profunda 

 vein. 



2. The internal circumflex artery is a larger 

 vessel than the external : it is given off by the 

 profunda usually after the external, and arises 

 from the inner side of the artery, but at times 

 it arises before the external. According to 

 Harrison it " very frequently proceeds from the 

 femoral artery, prior to the origin of the pro- 

 funda ;" it has been found by Burns* arising 

 from the external iliac artery, and also from the 

 femoral artery a little below the crural arch. 

 In the former case " it ran along the front of 



the lymphatic sheath ;" and in the second " it 

 traversed the front of the common sheath of 

 the great vein and also of the lymphatics ;" and 

 in either case, as observed by Burns, it must 

 be exposed to great danger in operation for 

 femoral hernia. According to Green,* both 

 circumflex arteries sometimes are furnished 

 from a common trunk. It runs inward, back- 

 ward, and downward toward the lesser tro- 

 chanter into the deepest part of the inguinal 

 region, and escapes from that space posteriorly 

 between the tendon of the psoas and the pecti- 

 nalis muscles ; continues its course backward, 

 on the inside of the neck of the femur and the 

 capsular ligament, below the obturator exter- 

 nus, behind the pectinalis, and anterior to the 

 adductor magnus and the quadratus muscles, 

 until it has got behind the neck of the bone ; 

 and lastly, it passes through the internal, which 

 separates the inferior margin of the quadratus 

 femoris from the upper margin of the adductor 

 magnus, and thus gains the posterior region of 

 the thigh, where it terminates as will be de- 

 scribed. 



The internal circumflex artery is the vessel 

 which gains the deepest situation in the groin : 

 it is internal and posterior to the profunda, and 

 when it arises from that artery, while external 

 to the femoral, it crosses the latter vessel poste- 

 riorly in its course. While within the inguinal 

 region the internal circumflex artery gives off 

 first a branch to the iliacus and psoas muscles : 

 then a considerable branch, denominated by 

 Tiedemann superficial circumflex branch, which 

 contributes to supply the pectinalis, the adduc- 

 tor longus, and the adductor brevis : it runs 

 upward and inward upon the pectinalis, at the 

 same time giving branches to it and to the ad- 

 ductor longus, until it reaches the interval be- 

 tween these muscles : it then divides into two, 

 of which one ascends in the course of the 

 original branch, between the muscles men- 

 tioned, toward the origin of the adductor longus, 

 supplying the two muscles, and ultimately 

 anastomosing with branches of the obturator 

 artery : small branches of it traverse the adduc- 

 tor, and become cutaneous upon the upper and 

 inner part of the thigh. The second branch 

 passes downward and backward, also between 

 the pectinalis and the adductor longus, gains 

 the anterior surface of the adductor brevis, and 

 there meets the obturator vessels and nerves : 

 it divides into several branches, of which some 

 are distributed to the last muscle, some anas- 

 tomose with the obturator artery, and others 

 with the upper perforating artery. 



Behind the pectinalis the internal circumflex 

 artery gives several branches. Downward it 

 gives a considerable one to the adductor mag- 

 nus, which descends into that muscle, supplies 

 it and anastomoses with the perforating arteries. 

 Upward and forward it gives to the adductor 

 brevis and the obturator externus branches 

 which communicate freely with the obturator 

 artery after its escape from the pelvis. Out- 

 ward it gives the articular artery of the hip a 

 branch, small, but remarkable for its course and 



* Op. cit. p. 319. 



* Op. cit. p. 31. 



