For foreign first-year students for autumn term Module Methodical elaboration for practice class on human anatomy for foreign first-year students for autumn term

Superficial Epigastric.

Deep External Pudendal.

Superficial Iliac Circumflex.

Muscular.

Superficial External Pudendal.

Profunda Femoris.

Highest Genicular.

The superficial epigastric artery (a. epigastrica superficialis) arises from the front of the femoral artery about 1 cm. below the inguinal ligament, and, passing through the femoral sheath and the fascia cribrosa, turns upward in front of the inguinal ligament, and ascends between the two layers of the superficial fascia of the abdominal wall nearly as far as the umbilicus. It distributes branches to the superficial subinguinal lymph glands, the superficial fascia, and the integument; it anastomoses with branches of the inferior epigastric, and with its fellow of the opposite side.

The superficial iliac circumflex artery (a. circumflexa ilium superficialis), the smallest of the cutaneous branches, arises close to the preceding, and, piercing the fascia lata, runs lateralward, parallel with the inguinal ligament, as far as the crest of the ilium; it divides into branches which supply the integument of the groin, the superficial fascia, and the superficial subinguinal lymph glands, anastomosing with the deep iliac circumflex, the superior gluteal and lateral femoral circumflex arteries.

The superficial external pudendal artery (a. pudenda externa superficialis; superficial external pudic artery) arises from the medial side of the femoral artery, close to the preceding vessels, and, after piercing the femoral sheath and fascia cribrosa, courses medialward, across the spermatic cord (or round ligament in the female), to be distributed to the integument on the lower part of the abdomen, the penis and scrotum in the male, and the labium majus in the female, anastomosing with branches of the internal pudendal.

The deep external pudendal artery (a. pudenda externa profunda; deep external pudic artery), more deeply seated than the preceding, passes medialward across the Pectineus and the Adductor longus muscles; it is covered by the fascia lata, which it pierces at the medial side of the thigh, and is distributed, in the male, to the integument of the scrotum and perineum, in the female to the labium majus; its branches anastomose with the scrotal (or labial) branches of the perineal artery.

The profunda femoris artery (a. profunda femoris; deep femoral artery) is a large vessel arising from the lateral and back part of the femoral artery, from 2 to 5 cm. below the inguinal ligament. At first it lies lateral to the femoral artery; it then runs behind it and the femoral vein to the medial side of the femur, and, passing downward behind the Adductor longus, ends at the lower third of the thigh in a small branch, which pierces the Adductor magnus, and is distributed on the back of the thigh to the hamstring muscles. The terminal part of the profunda is sometimes named the fourth perforating artery.

Lateral Femoral Circumflex.

Perforating.

Medial Femoral Circumflex.

Muscular.

The Lateral Femoral Circumflex Artery (a. circumflexa femoris lateralis; external circumflex artery) arises from the lateral side of the profunda, passes horizontally between the divisions of the femoral nerve, and behind the Sartorius and Rectus femoris, and divides into ascending, transverse, and descending branches.

The ascending branch passes upward, beneath the Tensor fasciæ latæ, to the lateral aspect of the hip, and anastomoses with the terminal branches of the superior gluteal and deep iliac circumflex arteries.

The descending branch runs downward, behind the Rectus femoris, upon the Vastus lateralis, to which it gives offsets; one long branch descends in the muscle as far as the knee, and anastomoses with the superior lateral genicular branch of the popliteal artery. It is accompanied by the branch of the femoral nerve to the Vastus lateralis.

The transverse branch, the smallest, passes lateralward over the Vastus intermedius, pierces the Vastus lateralis, and winds around the femur, just below the greater trochanter, anastomosing on the back of the thigh with the medial femoral circumflex, inferior gluteal, and first perforating arteries.

The Medial Femoral Circumflex Artery (a. circumflexa femoris medialis; internal circumflex artery) arises from the medial and posterior aspect of the profunda, and winds around the medial side of the femur, passing first between the Pectineus and Psoas major, and then between the Obturator externus and the Adductor brevis. At the upper border of the Adductor brevis it gives off two branches: one is distributed to the Adductores, the Gracilis, and Obturator externus, and anastomoses with the obturator artery; the other descends beneath the Adductor brevis, to supply it and the Adductor magnus; the continuation of the vessel passes backward and divides into superficial, deep, and acetabular branches. The superficial branch appears between the Quadratus femoris and upper border of the Adductor magnus, and anastomoses with the inferior gluteal, lateral femoral circumflex, and first perforating arteries (crucial anastomosis). The deep branch runs obliquely upward upon the tendon of the Obturator externus and in front of the Quadratus femoris toward the trochanteric fossa, where it anastomoses with twigs from the gluteal arteries. The acetabular branch arises opposite the acetabular notch and enters the hip-joint beneath the transverse ligament in company with an articular branch from the obturator artery; it supplies the fat in the bottom of the acetabulum, and is continued along the round ligament to the head of the femur.

The Perforating Arteries, usually three in number, are so named because they perforate the tendon of the Adductor magnus to reach the back of the thigh. They pass backward close to the linea aspera of the femur under cover of small tendinous arches in the muscle. The first is given off above the Adductor brevis, the second in front of that muscle, and the third immediately below it.

The first perforating artery (a. perforans prima) passes backward between the Pectineus and Adductor brevis (sometimes it perforates the latter); it then pierces the Adductor magnus close to the linea aspera. It gives branches to the Adductores brevis and magnus, Biceps femoris, and Glutæus maximus, and anastomoses with the inferior gluteal, medial and lateral femoral circumflex and second perforating arteries.

The second perforating artery (a. perforans secunda), larger than the first, pierces the tendons of the Adductores brevis and magnus, and divides into ascending and descending branches, which supply the posterior femoral muscles, anastomosing with the first and third perforating. The second artery frequently arises in common with the first. The nutrient artery of the femur is usually given off from the second perforating artery; when two nutrient arteries exist, they usually spring from the first and third perforating vessels.

The third perforating artery (a. perforans tertia) is given off below the Adductor brevis; it pierces the Adductor magnus, and divides into branches which supply the posterior femoral muscles; anastomosing above with the higher perforating arteries, and below with the terminal branches of the profunda and the muscular branches of the popliteal. The nutrient artery of the femur may arise from this branch. The termination of the profunda artery, already described, is sometimes termed the fourth perforating artery.

Numerous muscular branches arise from the profunda; some of these end in the Adductores, others pierce the Adductor magnus, give branches to the hamstrings, and anastomose with the medial femoral circumflex artery and with the superior muscular branches of the popliteal.

The highest genicular artery (a. genu suprema; anastomotica magna artery) arises from the femoral just before it passes through the opening in the tendon of the Adductor magnus, and immediately divides into a saphenous and a musculo-articular branch.

The saphenous branch pierces the aponeurotic covering of the adductor canal, and accompanies the saphenous nerve to the medial side of the knee. It passes between the Sartorius and Gracilis, and, piercing the fascia lata, is distributed to the integument of the upper and medial part of the leg, anastomosing with the medial inferior genicular artery.

The musculo-articular branch descends in the substance of the Vastus medialis, and in front of the tendon of the Adductor magnus, to the medial side of the knee, where it anastomoses with the medial superior genicular artery and anterior recurrent tibial artery. A branch from this vessel crosses above the patellar surface of the femur, forming an anastomotic arch with the lateral superior genicular artery, and supplying branches to the knee-joint.

The abdominal aorta divides, on the left side of the body of the fourth lumbar vertebra, into the two common iliac arteries. Each is about 5 cm. in length. They diverge from the termination of the aorta, pass downward and lateralward, and divide, opposite the intervertebral fibrocartilage between the last lumbar vertebra and the sacrum, into two branches, the external iliac and hypogastric arteries; the former supplies the lower extremity; the latter, the viscera and parietes of the pelvis.

The right common iliac artery is somewhat longer than the left, and passes more obliquely across the body of the last lumbar vertebra. In front of it are the peritoneum, the small intestines, branches of the sympathetic nerves, and, at its point of division, the ureter. Behind, it is separated from the bodies of the fourth and fifth lumbar vertebræ, and the intervening fibrocartilage, by the terminations of the two common iliac veins and the commencement of the inferior vena cava. Laterally, it is in relation, above, with the inferior vena cava and the right common iliac vein; and, below, with the Psoas major. Medial to it, above, is the left common iliac vein.

The left common iliac artery is in relation, in front, with the peritoneum, the small intestines, branches of the sympathetic nerves, and the superior hemorrhoidal artery; and is crossed at its point of bifurcation by the ureter. It rests on the bodies of the fourth and fifth lumbar vertebræ, and the intervening fibrocartilage. The left common iliac vein lies partly medial to, and partly behind the artery; laterally, the artery is in relation with the Psoas major.

The point of division is subject to great variety. In two-thirds of a large number of cases it was between the last lumbar vertebra and the upper border of the sacrum; being above that point in one case out of eight, and below it in one case out of six. The left common iliac artery divides lower down more frequently than the right.

The relative lengths, also, of the two common iliac arteries vary. The right common iliac was the longer in sixty-three cases; the left in fifty-two; while they were equal in fifty-three. The length of the arteries varied, in five-sevenths of the cases examined, from 3.5 to 7.5 cm.; in about half of the remaining cases the artery was longer, and in the other half, shorter; the minimum length being less than 1.25 cm., the maximum, 11 cm. In rare instances, the right common iliac has been found wanting, the external iliac and hypogastric arising directly from the aorta.

Collateral Circulation.—The principal agents in carrying on the collateral circulation after the application of a ligature to the common iliac are: the anastomoses of the hemorrhoidal branches of the hypogastric with the superior hemorrhoidal from the inferior mesenteric; of the uterine, ovarian, and vesical arteries of the opposite sides; of the lateral sacral with the middle sacral artery; of the inferior epigastric with the internal mammary, inferior intercostal, and lumbar arteries; of the deep iliac circumflex with the lumbar arteries; of the iliolumbar with the last lumbar artery; of the obturator artery, by means of its pubic branch, with the vessel of the opposite side and with the inferior epigastric.

1. The Hypogastric Artery—

(A. Hypogastrica; Internal Iliac Artery)

The hypogastric artery supplies the walls and viscera of the pelvis, the buttock, the generative organs, and the medial side of the thigh. It is a short, thick vessel, smaller than the external iliac, and about 4 cm. in length. It arises at the bifurcation of the common iliac, opposite the lumbosacral articulation, and, passing downward to the upper margin of the greater sciatic foramen, divides into two large trunks, an anterior and a posterior.

At birth, when the placental circulation ceases, the pelvic portion only of the artery remains patent and constitutes the hypogastric and the first part of the superior vesical artery of the adult; the remainder of the vessel is converted into a solid fibrous cord, the lateral umbilical ligament (obliterated hypogastric artery) which extends from the pelvis to the umbilicus.

The lengths of the common iliac and hypogastric arteries bear an inverse proportion to each other, the hypogastric artery being long when the common iliac is short, and vice versa.

The right and left hypogastric arteries in a series of cases often differed in length, but neither seemed constantly to exceed the other.

Superior Vesical.

Iliolumbar.

Middle Vesical.

Lateral Sacral.

Inferior Vesical.

Superior Gluteal.

Middle Hemorrhoidal.

Obturator.

Internal Pudendal.

Inferior Gluteal.

Uterine

Vaginal

The middle vesical artery (a. vesicalis medialis), usually a branch of the superior, is distributed to the fundus of the bladder and the vesiculæ seminales.

The inferior vesical artery (a. vesicalis inferior) frequently arises in common with the middle hemorrhoidal, and is distributed to the fundus of the bladder, the prostate, and the vesiculæ seminales. The branches to the prostate communicate with the corresponding vessels of the opposite side.

The middle hemorrhoidal artery (a. hæmorrhoidalis media) usually arises with the preceding vessel. It is distributed to the rectum, anastomosing with the inferior vesical and with the superior and inferior hemorrhoidal arteries. It gives offsets to the vesiculæ seminales and prostate.

The uterine artery (a. uterina) springs from the anterior division of the hypogastric and runs medialward on the Levator ani and toward the cervix uteri; about 2 cm. from the cervix it crosses above and in front of the ureter, to which it supplies a small branch. Reaching the side of the uterus it ascends in a tortuous manner between the two layers of the broad ligament to the junction of the uterine tube and uterus. It then runs lateralward toward the hilus of the ovary, and ends by joining with the ovarian artery. It supplies branches to the cervix uteri and others which descend on the vagina; the latter anastomose with branches of the vaginal arteries and form with them two median longitudinal vessels—the azygos arteries of the vagina—one of which runs down in front of and the other behind the vagina. It supplies numerous branches to the body of the uterus, and from its terminal portion twigs are distributed to the uterine tube and the round ligament of the uterus.

The vaginal artery (a. vaginalis) usually corresponds to the inferior vesical in the male; it descends upon the vagina, supplying its mucous membrane, and sends branches to the bulb of the vestibule, the fundus of the bladder, and the contiguous part of the rectum. It assists in forming the azygos arteries of the vagina, and is frequently represented by two or three branches.

The obturator artery (a. obturatoria) passes forward and downward on the lateral wall of the pelvis, to the upper part of the obturator foramen, and, escaping from the pelvic cavity through the obturator canal, it divides into an anterior and a posterior branch. In the pelvic cavity this vessel is in relation, laterally, with the obturator fascia; medially, with the ureter, ductus deferens, and peritoneum; while a little below it is the obturator nerve.

Branches.—Inside the pelvis the obturator artery gives off iliac branches to the iliac fossa, which supply the bone and the Iliacus, and anastomose with the ilio-lumbar artery; a vesical branch, which runs backward to supply the bladder; and a public branch, which is given off from the vessel just before it leaves the pelvic cavity. The pubic branch ascends upon the back of the pubis, communicating with the corresponding vessel of the opposite side, and with the inferior epigastric artery.

Outside the pelvis, the obturator artery divides at the upper margin of the obturator foramen, into an anterior and a posterior branch which encircle the foramen under cover of the Obturator externus.

The anterior branch runs forward on the outer surface of the obturator membrane and then curves downward along the anterior margin of the foramen. It distributes branches to the Obturator externus, Pectineus, Adductores, and Gracilis, and anastomoses with the posterior branch and with the medial femoral circumflex artery.

The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium, where it anastomoses with the anterior branch. It gives twigs to the muscles attached to the ischial tuberosity and anastomoses with the inferior gluteal. It also supplies an articular branch which enters the hip-joint through the acetabular notch, ramifies in the fat at the bottom of the acetabulum and sends a twig along the ligamentum teres to the head of the femur.