Anatomy - Right femoropopliteal PTFE bypass (P3)

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Arterial blood supply to the lower extremity

1. Femoral artery

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1,1. Overview

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
Distribution	Thigh Abdominal wall skin External genitalia Knee joint and proximal/medial lower leg

1,2. Major branches of femoral artery

	Branches	Distribution
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

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2,1. Overview

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
Distribution	Popliteal fossa Knee joint

2,2. Major branches of popliteal artery

	Course	Branches	Distribution
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:

Segment	Feature	Access
P1	From adductor hiatus to the top of the patella	Distal medial thigh
P2	From top of the patella to center of the knee joint	Posterior (popliteal fossa)
P3	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

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

3,2. Major branches of posterior tibial artery

	Course	Branches	Distribution
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

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