Ligation of Femoral Artery 457 



Irregularities. The common femoral artery may divide close 

 below Poupart's ligament, or as far down as the apex of Scarpa's 

 triangle ; in the latter case the circumflex branches come from the 

 common trunk. There may be two superficial femoral arteries. Oc- 

 casionally the femoral has been replaced by a giant sciatic artery 

 which has eventually become the popliteal. 



The femoral veins. The superficial femoral vein continues the 

 popliteal vein up through Hunter's canal, where it is lying external, 

 and then posterior to its artery ; through Scarpa's triangle where, 

 in its ascent, it gradually passes from behind to the inner side, until 

 it is joined, an inch and a half below Poupart's ligament, by the deep 

 femoral vein to form the common femoral. This last lies altogether 

 on the inner side of its artery, resting upon the pectineus. The 

 relations and the tributaries are much like those of the corresponding 

 arteries, with the exception that" the veins corresponding to the 

 branches of the common femoral artery enter the long saphenous vein, 

 itself a tributary of the common femoral. 



Compression of the common femoral artery against the ilio- 

 pectineal eminence and over the head of the femur is easily accom- 

 plished by the thumb, the fingers grasping the great trochanter. If 

 the circulation have to be controlled for a considerable time, the part 

 should be first cleanly shaved, washed and dried, and then dusted 

 with starch powder, a shot-bag being placed over the backs of the 

 fingers, whilst the tips are laid along the artery. The necessary force, 

 which is not great, should be directed a little upwards towards the 

 pubic ramus. 



The india-rubber tourniquet is applied by stretching it across the 

 thigh below the ischial tuberosity, crossing the stretched ends over a 

 pad in the groin, and taking them, spica-wise, front and back, to just 

 below the opposite iliac crest, where they are secured. 



If compression be made lower down the thigh, by a screw-tourniquet 

 for instance, a pad (a rib-roller) should be laid over the artery, in the 

 groove between the quadriceps and adductors ; the pressure being 

 directed outwards against the femur. 



legation of the common femoral has not been a popular opera- 

 tion, because the surgeon cannot be sure that the trunk is not divid- 

 ing high up, or that the circumflex trunks do not come from it. Then, 

 close above the ligature, the deep epigastric and the circumflex iliac 

 branches are given off, so that the risk of imperfect formation of the 

 clot and of recurrent haemorrhage is considerable. Ligation of the 

 external iliac has usually been the alternative operation, but in spite of 

 these objections ligation of the common femoral artery is often a very 

 proper operation. 



To secure the common femoral, the skin being shaved and cleansed, 

 a two-inch incision is made from a spot midway between the iliac 

 spine and pubic symphysis, through the skin and superficial fascia 



