Anatomy - Right femoropopliteal PTFE bypass (P3) – Vascular Surgery

  1. Arterial blood supply to the lower extremity

    1. Femoral artery 

    A 311-1
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    1,1. Overview
    • External iliac artery which becomes the femoral artery after passing posterior to the inguinal ligament
    • 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
    • Superficial epigastric artery
    • Superficial iliac circumflex artery
    • Deep femoral artery (main artery supplying the thigh!)
    • External pudendal arteries
    • Descending genicular artery
    • Thigh 
    • Abdominal wall skin
    • External genitalia
    • Knee joint and proximal/medial lower leg
    1,2. Major branches of femoral artery
    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

    2. Popliteal artery

    A 311-2
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    2,1. Overview
    • Continuation of femoral artery after it passes through the adductor hiatus
    • Runs through popliteal fossa
    • Passes between gastrocnemius heads
    • Becomes the tibiofibular trunk, after giving rise to the anterior tibial artery
    • Anterior tibial artery
    • Popliteal fossa
    • Knee joint
    2,2. Major branches of popliteal artery
    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

    From a surgical viewpoint, it is customary to divide the popliteal artery into three segments (P1–P3) which determine the surgical access routes:





    From adductor hiatus to the top of the patella

    Distal medial thigh


    From top of the patella to center of the knee joint

    Posterior (popliteal fossa)


    From center of the knee joint to anterior tibial artery origin

    Proximal medial lower leg

    The popliteal artery lies in a nerve-vascular (NV) bundle encased in fatty connective tissue. In segments P1 and P2, the artery is anteromedial to the popliteal vein, while in segment P3, it is surrounded by its accompanying veins. The tibial and common peroneal nerves lie posterolateral to the popliteal artery and vein. In the popliteal fossa, the nerves follow a rather superficial course, which must be taken into account when exposing the popliteal artery from the posterior aspect.

    The superficial and deep lymphatic drainage is bundled in the popliteal fossa via three to five perivenous lymph nodes.

    Due to its location, the popliteal artery is subjected to considerable mechanical loading, which is why, as a muscular-type artery, it has strong muscle and fiber layers (tunica media vasis, internal elastic membrane. Its mural characteristics thus resemble those of central elastic arteries.

    3. Posterior tibial artery

    3,1. Overview

    o    Continuation of popliteal artery distal to origin of anterior tibial artery


    o    Passes together with tibial nerve posterior to tendinous arch of soleus → Medial malleolar sulcus → Medial malleolus

    o    Bifurcates into medial + lateral plantar artery


    o    Fibular artery

    o    Medial + lateral plantar artery


    o    Dorsal aspect of lower leg

    o    Sole of foot

    3,2. Major branches of posterior tibial artery
    Fibular artery

    o    Courses along dorsal aspect of fibula 

    o    Lies posterior tibial and flexor hallucis longus muscles

    o    Communicating branch: Cross-connection to posterior tibial artery

    o    Lateral malleolar branches

    o    Lateroposterior lower leg

    Medial plantar artery

    o    Courses in medial neurovascular bundle of sole of foot (medial plantar artery, vein and nerve) between abductor hallucis and flexor digitorum brevis muscles

    o    Ø

    o    Medial sole of foot

    Lateral plantar artery

    o    Courses in lateral neurovascular bundle of sole of foot (lateral plantar artery, vein and nerve) between flexor digitorum brevis and quadratus plantae muscles

    o    Deep plantar arch: anastomosis between lateral plantar artery and deep plantar branch of dorsalis pedis artery at the metatarsals

    o    Lateral sole of foot

    o    Toes