492 THE ARTERIES OF THE LOWER LIMB. 



terminates in the profunda and other branches usually derived from the femoral artery. Ten 

 examples of this deviation from the normal condition of the vessels are recorded. 



In one instance met with by Tiedemann the external iliac artery divided near Poupart's 

 ligament into two parts, which united again at the level of the small trochanter. A some- 

 what similar case is figured by Dubrueil, in which a " vas aberrans " is given off from the lower 

 end of the external iliac artery, and descends on the inner side of the main trunk, to join the 

 femoral about an inch below the origin of the profunda. Several instances are recorded of 

 division of the femoral artery, below the origin of the profunda, into two vessels which 

 reunite a variable distance above the opening in the adductor magnus, so as to form a single 

 popliteal artery. 



Brandies. The deep femoral artery is sometimes given off from the inner side of the 

 parent trunk, and more rarely from the back part of the vessel. It has also been found in a 

 few instances arising from the front of the femoral artery, and winding inwards over the 

 femoral vein to gain its usual position below. Occasionally its origin is less than one inch, 

 or more than two inches, below Poupart's ligament. It was found by R. Quain, in one 

 instance arising above Poupart's ligament, and in another four inches below that band ; but 

 in the latter case the internal and external circumflex arteries did not arise from the pro- 

 funda. As a very rare occurrence, absence of the profunda has been met with, the circumflex 

 and perforating arteries arising separately from the femoral trunk (Hyrtl, A. H. Young). 



The external circumflex artery sometimes arises directly from the femoral ; or it may be 

 represented by two branches, of which, in most cases, one proceeds from the femoral, the 

 other from the profunda ; both branches, however, occasionally arise from the profunda, 

 much more rarely from the femoral artery. 



The internal circumflex artery may be transferred to the femoral above the origin of the 

 profunda. Examples have also been met with in which the internal circumflex arose from 

 the epigastric, from the circumflex iliac, or from the external iliac artery. 



In a large number of cases (578) the profunda failed to give the external circumflex in 15 

 per cent., the internal circumflex in 21 per cent., and both circumflex arteries in 4 per cent. 

 (R. Quain ; J. Srb). 



Many occasional branches have been seen arising from the femoral, as the deep epigastric, 

 circumflex iliac, or an aberrant obturator artery ; more rarely the ilio-lumbar, or the dorsal 

 artery of the penis. The great saphenous artery is a branch that has been occasionally met 

 with. It arises either above or below the origin of the profunda, and running at first between 

 the vastus internus and adductor magnus muscles, it issues from the lower end of Hunter's 

 canal to reach the inner aspect of the knee, whence it accompanies the internal saphenous 

 vein even as far as the internal malleolus. This vessel is normal in many mammals. 



SURGICAL ANATOMY OF THE FEMORAL ARTERY. 



Ligature of the common femoral artery is occasionally practised, and has been successful in 

 several cases. The proximity of the epigastric and circumflex iliac branches of the external 

 iliac artery, the presence of a number of small anastomosing branches springing from the 

 trunk itself, and the possibility of the profunda, or one of the circumflex arteries, arising at a 

 higher level than usual must, however, be borne in mind in considering the propriety of 

 applying a ligature to this part of the vessel. 



In performing the operation, the integument and the iliac portion of the fascia lata are 

 divided either by a transverse incision one inch and a half long, with its centre placed over 

 the artery, carried parallel to and half an inch below Poupart's ligament, or by a longitudinal 

 incision of equal extent in the line of the vessel (p. 487), commencing close below Poupart's 

 ligament. Any superficial arteries that have been cut being secured, the femoral sheath is 

 then laid open, and the artery freed from its areolar investment. The vein is here to the 

 inner side of the artery, and, being separated from that vessel by a septum in the femoral 

 sheath, does not come into view. The needle should be passed from within outwards. 



The superficial femoral artery may be tied either immediately below Scarpa's triangle, or 

 in Hunter's canal. The former position is that usually preferred by surgeons, owing to the 

 superficial position of the vessel, and its freedom from large branches. The hip having been 

 slightly flexed, and the thigh everted, an incision about three and a half inches long, and so 

 placed that its centre is about four and a half inches from Poupart's ligament, is made in the 

 line of the artery. The integument and fascia lata are cut through at once, and the sartorius 

 muscle exposed. The inner border of the sartorius is then raised and drawn well outwards, 

 together with the internal cutaneous nerve which lies along this edge of the muscle (fig. 388), 

 and the sheath of the artery is opened in the centre of the incision and separated from the 

 vessel. The femoral vein is not seen, as it is placed behind the artery, only a very thin layer of 

 connective tissue being interposed between the two. The needle is to be passed from within 



