Anatomy - Right transfemoral amputation in Fontaine stage IV peripheral arterial disease

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Arterial pelvic blood supply

The abdominal aorta divides at the aortic bifurcation (around level L4) into both common iliac arteries
In turn, each common iliac artery divides into an internal and external iliac artery
With its visceral branches, the internal iliac artery supplies mainly the pelvic organs, while its parietal branches ensure the blood supply to the lower extremities
The external iliac artery contributes to the pelvic blood supply and, after passing through the vascular compartment (lacuna vasorum retroinguinalis), becomes the femoral artery

Origin	Arises from the common iliac artery immediately inferior to the aortic bifurcation
Course	Courses caudad over the superior border of the greater sciatic foramen.
Relation	Posterior: internal iliac vein, pirirformis muscle, lumbosacral plexus Anterior: ureter Lateral: external iliac vein, psoas major Inferior: obturator nerve
Branches	Visceral branches: Umbilical arteries Inferior vesical artery Middle rectal artery In women: Uterine artery Parietal branches: Iliolumbar artery Lateral sacral arteries Superior gluteal artery Inferior gluteal artery Obturator artery Internal pudendal artery
Arterial blood supply for	Pelvic organs, gluteal muscles

Origin	Arises from the common iliac artery immediately distal to the origin of the internal iliac artery
Course	Courses along the major psoas muscle to the inguinal ligament, and after passing through the vascular compartment becomes the femoral artery
Relation	The right external iliac artery courses posterior to the ureter The left ureter crosses somewhat lower anterior to the bifurcation of the external iliac artery
Branches	The deep iliac circumflex artery courses to the superior iliac spine and joins the Iliolumbar artery and superior gluteal artery The inferior epigastric artery runs craniad medial to the deep inguinal ring and between the transverse abdominis and rectus abdominis muscles; other branches include the cremasteric artery and artery of round ligament of uterus
Arterial blood supply for	Iliac bone, inferior aspect of abdominal wall

Origin	External iliac artery which becomes the femoral artery after passing posterior to the inguinal ligament
Course	Passes between the iliopsoas and pectineus muscles (= iliopectineal fossa) covered by fascia lata Accompanied as far as the mid-thigh by the sartorius muscle Passes together with the femoral vein and saphenous nerve through the adductor canal (Hunter) Becomes the popliteal artery after passing through the adductor hiatus
Branches	Superficial epigastric artery Superficial iliac circumflex artery Deep femoral artery (main artery supplying the thigh!) External pudendal arteries Descending genicular artery
Arterial blood supply for	Thigh Abdominal wall skin External genitalia Knee joint and proximal/medial lower leg

	Branches	Arterial blood supply for
Superficial epigastric artery	Ø	Abdominal wall skin up to the umbilical region
Superficial iliac circumflex artery	Ø	Superior anterior iliac spine
Deep femoral artery	The medial femoral circumflex artery courses posteriad between iliopsoas and pectineus muscles → trochanteric fossa; anastomosis with lateral femoral circumflex artery The lateral femoral circumflex artery runs laterad between the rectus femoris and vastus muscles; anastomosis with the medial femoral circumflex artery The perforating arteries course through the adductors to the posterior aspect of the thigh	Thigh
External pudendal arteries	Ø	External genitalia Scrotum / major pudendal labia
Descending genicular artery	Articular branches → Rete articulare genus Saphenous branch → courses medially to calf together with the great saphenous vein and saphenous nerve	Knee Proximal medial calf

Origin	Continuation of femoral artery after it passes through the adductor hiatus
Course	Runs through popliteal fossa Passes between gastrocnemius heads Becomes the tibiofibular trunk, after giving rise to the anterior tibial artery
Branches	Anterior tibial artery
Arterial blood supply for	Popliteal fossa Knee joint

	Course	Branches	Arterial blood supply for
Anterior tibial artery	Branch of popliteal artery Accompanied by two veins and, in its inferior aspect, by deep peroneal nerve Passes through interosseous membrane of leg and courses on its anterior aspect Passes posterior to extensor hallucis longus tendon Becomes the dorsalis pedis artery	Posterior + anterior tibial recurrent artery Lateral + medial anterior malleolar artery Dorsalis pedis artery (terminal branch of anterior tibial artery)	Anterior lower leg Dorsum of foot

Origin	Continuation of popliteal artery distal to origin of anterior tibial artery
Course	Passes together with tibial nerve posterior to tendinous arch of soleus → Medial malleolar sulcus → Medial malleolus Bifurcates into medial + lateral plantar artery
Branches	Fibular artery Medial + lateral plantar artery
Arterial blood supply for	Dorsal aspect of lower leg Sole of foot

	Course	Branches	Arterial blood supply for
Fibular artery	Courses along dorsal aspect of fibula Between posterior tibial and flexor hallucis longus muscles	Communicating branch: Cross-connection to posterior tibial artery Lateral malleolar branches	Lateroposterior lower leg
Medial plantar artery	Courses in medial neurovascular bundle of sole of foot (medial plantar artery, vein and nerve) between abductor hallucis and flexor digitorum brevis muscles	Ø	Medial sole of foot
Lateral plantar artery	Courses in lateral neurovascular bundle of sole of foot (lateral plantar artery, vein and nerve) between flexor digitorum brevis and quadratus plantae muscles	Deep plantar arch: anastomosis between lateral plantar artery and deep plantar branch of dorsalis pedis artery at the metatarsals	Lateral sole of foot Toes