Download Common origin of the medial circumflex femoral and inferior

OLGU SUNUMU/CASE REPORT
Gülhane Tıp Derg 2012; 54: 323-325
© Gülhane Askeri Tıp Akademisi 2012
doi:10.5455/gulhane.30580
Common origin of the medial circumflex femoral
and inferior epigastric arteries from the femoral
artery
Selda Yıldız (*), Fatih Yazar (*)
SUMMARY
Classically, the inferior epigastric artery is a branch of the external iliac artery before it becomes the femoral artery. It may arise from different origin
and this kind of differences was important for vascular attempts of this region. Variation of these arteries carries weight for reconstruction of perine,
scrotum, head (especially maxilla) and neck. We believe that; the proper
and efficient demonstration of this variation will add important contribution
to our knowledge.
A variation of the inferior epigastric artery was observed during routine dissection of a 74-year-old male cadaver. In our case, inferior epigastric artery
appeared as a common trunk with medial circumflex femoral artery, which
leaves femoral artery. This case of common origin of the medial circumflex
femoral and inferior epigastric arteries from the femoral artery is different
from comparing with rare cases from the literature. Knowledge about anatomical variations regarding origins of the femoral artery proximal branches
should keep in mind and is important for clinicians in the interventional
radiology.
Key words: Inferior epigastric artery, medial circumflex femoral artery
ÖZET
Arteria femoralis’den ayrılan arteria epigastrica inferior ve arteria
circumflexa femoris medialis’in ortak orijini
Klasik olarak a.epigastrica inferior, a.iliaca externa’nın a.femoralis olmadan
önceki dalıdır. Değişik noktalardan köken alabilir ve bu tür farklılıklar bu
bölgenin vasküler girişimleri için önemlidir. Bu arterlerin varyasyonu perine,
scrotum, baş (özellikle maxilla) ve boyun rekonstrüksiyonunda önemlidir.
Biz bu varyasyonun tam ve etkin olarak gösterilmesinin bilgilerimize önemli
katkı sağlıyacağını düşünüyoruz.
Yetmişdört yaşındaki erkek kadavranın rutin disseksiyonu sırasında a.epigastrica inferior varyasyonuna rastlandı. A.epigastrica inferior,
a.circumflexa femoris medialis ile birlikte a.femoralis’den ayrılan ortak
bir kök olarak izleniyordu. Literatürdeki nadir olgularla karşılaştırıldığında
a.circumflexa femoris medialis’in ve a.epigastrica inferior’un a.femoralis’den
ortak orijinli ayrılışı farklılık gösterir. A.femoralis’in proximal dallarının varyatif orijinleri girişimsel radyolojide klinisyenler için önemlidir ve akılda
tutulmalıdır.
Anahtar kelimeler: A.epigastrica inferior, a.circumflexa femoris medialis
Introduction
The femoral artery is a continuation of the external iliac artery. The femoral artery gives off several
branches in the proximal thigh, including the superficial epigastric, superficial circumflex iliac, superficial external pudendal, deep external pudendal and
profunda femoris arteries. The medial and the lateral
circumflex femoral arteries usually originates from
the the profunda femoris, but sometimes originates
from the femoral artery. Classically, the inferior epigastric artery (IEA) is a branch of the external iliac artery before it becomes the femoral artery. It may arise
from the femoral artery or from the external iliac artery in common with the obturator artery(1).
Preparatory ligation of the IEA is often performed
for myo(cutaneous) flaps using the mid or lower rectus abdominis based on the superior epigastric artery
to allow expansion of the superior arterial flow to improve viability of the flap. Branches anastomose with
terminal branches of the lower six posterior intercostal arteries posterior to rectus abdominis at the lateral
border close to the sheath. The artery is an important
inferomedial relation of the deep inguinal ring, and
may be damaged during extensive medial dissection
of the deep ring during hernia repair, particularly
when this is performed in the preperitoneal plane.
The vas deferens in the male, or round ligament in
the female, wind laterally round it. It has the following branches: the cremasteric artery, a pubic branch,
and muscular and cutaneous branches(1).
Importance of variation of these arteries for reconstruction of perine, scrotum, head (especially maxilla) and neck is cited in literature(2,3,4,5).
*Gulhane Military Medical Academy, Department of Anatomy
Reprint request: Dr. Selda Yıldız, Gulhane Military Medical Academy,
Department of Anatomy, Etlik-06018, Ankara, Turkey
E-mail: [email protected]
Date submitted: August 02, 2011 Date accepted: September 08, 2011 Online publication date: December 26, 2012
Case Report
In our case it was detected that in 74 years old male
cadaver, IEA appeared as a common trunk with me323
dial circumflex femoral artery (MCFA), which leaves
femoral artery (Figs. 1). This common trunk was separated from femoral artery medially and 6.9 mm distally from the mid point of inguinal ligament. The
trunk was separated into two branches after 7 mm
while MCFA showed a normal course and branching
pattern, IEA moved towards supero-medial, passed
under the inguinal ligament and extends to the anterior wall of the abdomen in rectus sheath along with
the inferior epigastric vein. Lateral circumflex femoral artery, which was the other branch of the femoral
artery, was separated from the lateral side of femoral
artery and 30.22 mm distally from the mid point of
inguinal ligament. Deep femoral artery was separated
from postero-lateral side of the femoral artery and
59.7 mm distally from the middle point of inguinal
ligament.
Discussion
Adachi(6), stated that the IEA and MCFA arise from
the external iliac and deep femoral arteries, respectively. In addition to this; the IEA and obturator ar-
Figure 1. Anterior view of the femoral region and related structures. 1;
inferior epigastric artery, 2; medial circumflex femoral artery, *; common trunk, IL; inguinal ligament, IPM; iliopsoas muscle, SM; sartorius
muscle, FA; femoral artery, FV; femoral vein, 3; lateral circumflex femoral artery, 4; deep femoral artery.
324 • December 2012 • Gulhane Med J
tery arising with a common origin is a well-known
and relatively frequent anomaly, occurring in 20–
30% of cadavers(7,8). Seldom, there are also some
cases about IEA originating from the MCFA(9), the
deep femoral artery (10) or a common trunk together
with the IEA, which is extremely rare(11).
In a large number of investigations including angiographies the femoral artery was mentioned as
preferred and easily accessible to catheterization.
Knowledge about anatomical variations regarding origins of the femoral artery proximal branches should
keep in mind and is important for clinicians in the
interventional radiology(12).
The extended deep inferior epigastric perforator artery flap had been described in 1983. For head and
neck reconstruction, Masià J et all. have been used a
variation of this flap, namely a perforator free flap of
the deep inferior epigastric system with a superolateral extension of the skin paddle. The extended deep
inferior epigastric perforator flap is reliable, has a safe
vascular supply, and has a long pedicle. Its versatility
makes it suitable for reconstruction of moderate to
large head and neck reconstruction(4).
Zhang YX et all. evaluated the efficacy of the distinct free flaps in reconstruction of different types of
maxillectomy defects(5).
Coskunfirat et all. mentioned that the medial
circumflex femoral artery perforator flap is a good
option with its good mobility, thinness for scrotal
contour, possibility for muscle preservation, and direct closure of the donor site for scrotal reconstruction(2).
Reconstruction using six local medial circumflex
femoral artery perforator flaps was undertaken in five
male patients with complex penoscrotal or perineal
wounds by Karsidag et all(3).
Variations in the origin of the profunda femoris
artery, lateral circumflex femoral artery and MCFA
are commonly observed. This case of common origin
of the MCFA and IEA from the femoral artery is different, comparing with rare cases from the literature.
The proper and efficient demonstration and evaluation of this variation and its figure will add important
contribution to the literature.
References
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Yıldız et al.
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Superiority of Medial Circumflex Femoral Artery
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Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap. Microsurgery. 2011
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