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Journal of the Anatomical Society of India

Variations in the Origin and Course of Profunda Femoris

Author(s): Dixit, D.P., Mehta, L.A., Kothari, M.L.

Vol. 50, No. 1 (2001-01 - 2001-06)

Department of Anatomy, Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai. INDIA

For Reprints, request the first author.

Abstract

Dissections of 48 femoral triangles in 24 human cadavers revealed interesting data in the origin and course of theprofunda femoris as well as the circumflex femoral arteries. Apart from the usual description about the arteries as available in the anatomytext, we came across several interesting variations.

The site of origin of the profunda was most commonly located midway between the inguinal ligament and the apex of the femoraltriangle. Very few origins were above and below this midpoint. The profunda was unduly large in 2 instances, in 2 different individuals. Theopposite-slender profunda was not encountered. The circumflex femoral arteries commonly sprung from the profunda. In 12 thighshowever, they arose directly from the femoral above the origin of profunda. One medial circumflex femoral travelled superiorly up to theinguinal ligament before turning to wind around the femoral neck.

Key words : Profunda femoris artery, inguinal ligament, medial circumflex femoral artery, lateral circumflex femoral artery.

Introduction :

Barely two months after the discovery of X-rays by Wilhelm Roentgen, Haschek and Lindenthal first attempted vascular imaging in 1896. They used lime, cinnabar and petroleum products in the brachial artery as contrast medium. Even after the advent of highly advanced imaging techniques, arteriography still remains the main line investigation in peripheral occlusive arterial diseases. Peripheral arteriograms are used nowadays to evaluate peripheral occlusive arterial diseases, suspected congenital anomalies, arterial status in trauma, imaging of vascular malignancies, demonstration of the vascularity of malignancies and identifying diseases inherent to the arterial system. The femoral artery is easily accessible to catheterization and thereby to investigation any arterial system in the body. The profunda femoris artery is used for arteriography, ultrasound and doppler imaging, digital subtraction angiography and magnetic resonance imaging. The expanding scope of interventional radiology has prompted this study on the variation of the profunda femoris artery.

Material and Methods :

A series of 48 femoral triangles in 24 human cadavers were dissected. The skin was incised and reflected, followed by the superficial fascia. The superficial inguinal lymph nodes along with the superficial vessels were identified and the fascia lata was incised thus exposing the femoral triangle. The inguinal canal was identified, so were the adductor longus and sartorius muscles. The femoral sheath was identified and its compartments were dissected thus clearing the femoral artery and its major branches. The profunda femoris artery with its medial and lateral circumflex femoral branches were dissected and identified, their origin and course were studied. The relation of the profunda femoris at its origin to the femoral artery was studied. The distance of the site of origin of the profunda from the midpoint of the inguinal ligament was measured in millimeters with a scale and a caliper. The site of origin of the medial and lateral circumflex femoral arteries were studied and the distance of site of origin of each of them from the origin of profunda femoris was measured in millimeters.

Observations :

The profunda femoris artery originated from the posterolateral aspect of the femoral artery in 17 out of 48 cases i.e. 35.41% and from the posterior aspect in 15 out of 48 cases i.e. 31.25%. The profunda was unduly large in 2 limbs, which was unilateral in 2 different cadavers. The distance of origin of profunda femoris from the midpoint of the inguinal ligament on the right side was mostly between 41 and 52 mm (Table I), whereas on the

TABLE I DISTANCE OF ORIGIN OF PROFUNDA FEMORIS FROM THE MIDPOINT OF INGUINAL LIGAMENT ON THE RIGHT SIDE. Range (mm) No. of cases

Range (mm) No. of cases
31 – 40 5
41 – 52 11
53 – 64 5
65 – 76 2
77 – 88 1

left side it was between 46 and 54 mm (Table II). The origin of the lateral circumflex femoral artery on the right side was from the profunda femoris in 75%, from the profunda femoris common stem in 16.67% and from the femoral artery in 8.33% of cases. On the left side it originated from the profunda femoris in 91.67% and from the profunda femoris common stem in 8.33% of cases. The distance of origin of the lateral circumflex femoral artery from the origin of the profunda was between 23 and 34 mm (Table III). Fig. 1 shows the profunda femoris giving its

TABLE II DISTANCE OF ORIGIN OF PROFUNDA FEMORIS FROM THE MIDPOINT OF INGUINAL LIGAMENT ON THE LEFT SIDE.

Range (mm) No. of cases
19 – 27 3
28 – 36 5
37 – 45 4
46 – 54 7
55 – 63 5

TABLE III: DISTANCE OF ORIGIN OF LATERAL CIRCUMFLEX FEMORAL FROM ORIGIN OF PROFUNDA

Range (mm) No. of cases
On right side
No. of cases On left side
0 – 10 3 1
11 – 22 5 3
23 – 34 13 11
35 – 45 2 8
46 – 55 1 1

lateral circumflex femoral branch near its origin. Fig. 2 depicts the lateral circumflex artery arising from the femoral artery superior to the profunda. Fig. 3 shows the same as a digital subtraction angiogram of the femoral artery. In fig. 4 the lateral circumflex arises from the femoral inferior to the profunda. On the right side the medial circumflex femoral artery was arising from the profunda in 50%, from the femoral in 29.12% and from the profunda femoris common stem in 20.88% of cases. On the left side it originated from profunda femoris in 75%, from the femoral in 12.5% and from the profunda femoris common stem in 12.5% of cases. The distance of origin of the medial circumflex femoral from the origin of the profunda was between 21 and 30mm on the right while on the left it was between 11 and 30mm (Table IV). Fig.5 shows the medial circumflex femoral originating from the femoral superior to the profunda and the same is shown as a digital subtraction angiogram of the femoral artery in Fig. 6. Fig. 7 shows a case in which the medial circumflex femoral artery was arising from the femoral superior to the profunda and was placed anterior to the femoral vein before winding around the femoral neck. Thus it was observed that the medial circumflex femoral has a more variable origin from the femoral artery than the lateral circumflex femoral, which mostly arises from the profunda femoris.

TABLE IV DISTANCE OF ORIGIN OF MEDIAL CIRCUMFLEX FEMORAL FROM ORIGIN OF PROFUNDA

Range
(mm)
No. of cases
On right side
No. of cases
On left side
0 – 10 5 3
11 – 20 5 7
21 – 30 7 7
31 – 40 5 4
41 – 50 1 3
51 – 60 1 0

Discussion :

The profunda femoris artery in our study originated mostly from the posterolatral side of the femoral artery as is mentioned by Bannister et al, (1995). The average distance of origin of profunda femoris from the midpoint of inguinal ligament was 47.5mm that was more than 35mm and 40mm mentioned by Bannister et al (1995) and Snell (1992). The knowledge of the site of origin of the profunda helps in avoiding iatrogenic femoral arterio-venous fistula while performig femoral artery puncture. The lateral circumflex femoral artery mostly originated from the profunda. The medial circumflex artery on an average was arising in 62.5% of cases from the profunda and in 20.63% of cases from the femoral. This is comparable to 59% and 36% found by Lipshutz (1916) and 53% and 40% reported by Clarke and Colborn (1993). The case in which the medial circumflex femoral artery was found going anterior to the femoral vein as shown in Fig. 7 is significant as it may be damaged while collecting blood in infants from the femoral vein. It is also at risk during exposure of the saphenous vein for ligation at its junction with the femoral vein.

References :

  1. Bannister, L.H; Berry, M.M; Collins, P; Gray’s Anatomy. In: Cardiovascular system. 38th Edn.; Churchill Livingstone, Medical Division of Longman Group, UK Ltd. pp. 1566-8. (1995).
  2. Clark, S.M., and Colborn, G.L. (1993): The medial femoral artery: its clinical anatomy and nomenclature. Clinical Anatomy. 6: 94-105.
  3. Lipchutz, B.B. (1916): Studies on the blood vascular tree, 1, A composite study of the femoral artery. Anatomical Record. 10: 361-70.
  4. Snell, R.S; Clinical Anatomy of Medical Students. 4th Edn. Little Brown and Co. Boston p. 607. (1992)

J. Anat. Soc. India 50(1) 6-7 (2001) Opp. 6 Profunda Femoris

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Fig 1. Profunda femoris giving its lateralcircumflex branch near its origin. Fig 5.

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Fig 2: Lateral circumflex arising from femoral superior to the profunda.

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Fig 3: Digital subtraction angiogram of thefemoral artery showing lateral circumflex arising from femoral superior to profunda.

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Fig 4: Lateral circumflex arising from the femoral inferior to the profunda. Fig 6.

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Fig 5: Medial circumflex arising from femoral superior to profunda.

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Fig 6: Digital subtraction angiogram of femoral artery showing medialcircumflex arising from femoral superior to profunda.

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Fig 7: Medial circumflex arising from femoral superior to profunda and placed anterior to femoral vein.

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