FEMORAL ARTERY. 1015 



In order to pass the ligature, it is necessary to divide the thin and some- 

 times resistent subserous membrane, which binds the vessel down to the 

 fascia iliuca. 



SURGICAL ANATOMY OF THE FEMORAL ARTERY. 



The femoral artery (p. 434) is accessible to the surgeon for the application 

 of a ligature without serious difficulty in its en tire length ; but, as the lower 

 half is deeply placed, the difficulty of reaching this part is greatest, and 

 renders it necessary to divide and disturb the surrounding structures to a 

 greater extent than where the vessel is nearer the surface. For these 

 reasons the upper part of the artery is to be preferred for the performance 

 of the operation adverted to, in all cases in which other circumstances do 

 not control the choice of the surgeon. But the upper part of the femoral 

 artery is not equally eligible for the application of a ligature at all points, 

 in consequence of the position of the branches an important consideration 

 in the surgical anatomy of this vessel. 



Close to the commencement of this artery are two considerable branches 

 (epigastric and circumflex iliac) ; and between one and two inches lower 

 down the deep femoral branch ordinarily takes its rise. A ligature placed 

 on the arterial trunk in the interval between those branches, that is to say, 

 on the common femoral artery, is in the near neighbourhood of two dis- 

 turbing causes, two sources of danger, so near that the prospect of a favour- 

 able issue to the operation is, under ordinary circumstances, very small. 



Moreover, it has been shown amid the facts detailed before (p. 441), that 

 the origin of the deep femoral is often less than the average distance from 

 Poupart's ligament ; and that, not unfrequently, a considerable branch (one 

 of the circumflex arteries) takes its rise from the common femoral artery. 

 When these circumstances are considered, the operation of tying the 

 common femoral artery, or the femoral artery within two inches of ita 

 commencement, must be regarded as very unsafe. And it may be added, 

 that the conclusion to which the anatomical facts would lead is fully 

 confirmed by the results of cases in which the operation has been actually 

 performed. 



It remains to determine where a ligature applied to the main artery 

 shall be sufficiently distant from the origin of the deep femoral below it, to 

 be free from the disturbing influence of the circulation through that great 

 branch. It has been shown that now and then a case occurs in which the 

 profunda is given off at the distance of from two to three inches below Pou- 

 part's ligament in only a single instance out of a large number of observa- 

 tions did the space referred to amount to four inches. 



From the foregoing remarks the inference to be deduced is, that the- part 

 of the femoral artery to be preferred for the operation supposed, is at the 

 distance of between four and five inches below the lower margin of the 

 abdominal muscles. 



Remarks on the ojjeration. The position of the artery being determined, 

 and the integument and fat divided, a vein may be met with lying on the 

 fascia, over the course of the artery. Ihe saphenous vein, being nearer to 

 the inner side of the limb than the line of incision, is not seen in the opera- 

 tion. The fascia lata, which is now to be divided, has a more opaque ap- 

 pearance over the vessels than over the muscles, for the colour of the latter 

 appears through the membrane. After dividing the fascia, the edge of the 

 sartorius muscle will, in many cases, require to be turned aside ; and occar 



