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129 Vascular Anatomy of the Lower Extremities The external iliac artery becomes the common femoral artery after passing under the inguinal ligament. The common femoral artery and vein are enveloped by the femoral sheath. Scarpa’s triangle is defined by the adductor longus muscle medially, the Sartorious muscle laterally, and by the inguinal ligament superiorly. The femoral vessels and nerves are in the following orientation lateral to medial: femoral nerve, femoral artery, femoral vein, and lymphatics (NAVeL). The common femoral artery gives off several branches that include the superficial epigastric artery, the superficial circumflex artery, and the superficial and deep external pudendal arteries. The fossa ovalis is a medial opening in the fascia lata where the saphenous vein enters the femoral triangle. Approximately 4 cm below the inguinal ligament, the common femoral artery splits into the superficial femoral artery and the profunda (deep femoral artery). The profunda courses medially and posteriorly to the femur, giving rise to medial and lateral femoral circumflex arteries and perforating branches to supply the muscles of the flexor compartment and the femur. An important junction is created between the geniculate arteries of the knee and the descending branch of the lateral femoral circumflex artery. This creates a source of collateral blood flow when the superficial femoral artery is occluded. The superficial femoral artery continues inferiorly through the adductor canal (Hunter’s canal) after the origin of the profunda. Hunter’s canal begins at the apex of the femoral triangle. It is bordered by the vastus medialis on the anterolateral aspect, the adductor longus muscle on the posterior border, and by the Sartorious muscle superiorly. Hunter’s canal contains the superficial femoral artery, the saphenous nerve, and the nerve to the vastus medialis. The saphenous nerve departs the canal through the adductor hiatus to join the saphenous vein, traveling toward the medial ankle and foot. The adductor hiatus marks the end of the superficial femoral artery and the beginning of the popliteal artery. The popliteal artery travels inferiorly between the femoral condyles and deep to the soleus muscle. As the popliteal artery courses through the popliteal fossa, it gives multiple branches of geniculate arteries (superior lateral and medial geniculate arteries, inferior lateral and medial geniculate arteries). The popliteal vein lies posterolateral to the artery in the adductor hiatus, dorsal to the artery behind the knee, and then moves medial to the artery inferiorly. The small saphenous vein joins the popliteal vein in the popliteal fossa. Approximately 3 cm below the knee, the popliteal artery bifurcates into the anterior tibial artery and the tibioperoneal trunk. The anterior tibial artery exits the deep posterior compartment through the interosseous membrane and enters the anterior compartment medial to the fibula. Here it is joined by the deep peroneal nerve and continues to travel through the anterior compartment toward the dorsum of the foot. The dorsalis pedis artery begins as a continuation of the anterior tibial artery beginning anterior to the ankle joint. The dorsalis pedis artery traverses the dorsum of the foot in between the tendons of the extensor hallucis longus and the extensor digitorum longus. The dorsalis pedis has named branches, including the tarsal arteries (medial and lateral), the arcuate artery, and the first dorsal metatarsal artery. The metatarsal arteries (second, third, and fourth) arise from the arcuate artery. The dorsalis pedis artery terminates as the deep plantar artery and joins the plantar arch on the sole of the foot. The tibioperoneal trunk travels in the deep posterior compartment approximately 3 cm distally and then divides into the posterior tibial artery and the peroneal artery. The posterior tibial artery travels along with the tibial nerve in a medial course toward the medial malleolus. The peroneal artery travels in a lateral direction toward the ankle medial to the fibula. It terminates in branches to the ankle and the heel. The posterior tibial artery passes posterior to the medial malleolus and terminates into the medial and lateral plantar arteries. The plantar arch is formed from a communication between the deep plantar artery and the lateral plantar artery. 297