International Journal of Biological & Medical Research

Transcription

1 Int J Biol Med Res. 0; (): Int J Biol Med Res Volume, Issue, Ot 0 BioMedSiDiret Publiations Contents lists available at BioMedSiDiret Publiations International Journal of Biologial & Medial Researh Journal homepage: International Journal of BIOLOGICAL AND MEDICAL RESEARCH Original Artile A Study Of Variations In The Origin Of Profunda Femoris Artery And Its Cirumflex Branhes. a* b e Daksha Dixit, Dharati M. Kubavat, Sureshbhai P. Rathod, Mital M. Pateld, Tulsibhai C. Singel a Professor, Department of Anatomy, KLE University's Jawaharlal Nehru Medial College, Belgaum 59000, Karnataka, India b Assistant Professor, Department of Anatomy, M. P. Shah Medial College, Jamnagar 008, Gujarat, India Professor & Head, Department of Anatomy, Government Medial College, Bhavnagar 000, Gujarat, India d Assoiate Professor, Department of Anatomy, M. P. Shah Medial College, Jamnagar 008, Gujarat, India e Professor & Head, Department of Anatomy, M. P. Shah Medial College, Jamnagar 008, Gujarat, India A R T I C L E I N F O A B S T R A C T Keywords: Femoral artery Lateral irumflex femoral artery Medial irumflex femoral artery Profunda. The knowledge of the variations in site of origin and ourse of the profunda and its irumflex branhes has great linial importane during diagnosti imaging proedures as well as during surgeries that are performed in the femoral triangle. We disseted 8 femoral triangles in human adavers whih revealed interesting variations apart from the usual desription about these arteries that is available in standard anatomy textbooks. The most ommon site of origin of profunda was from the posterolateral aspet of the femoral artery. A rare variation of the profunda arising from either posterior or medial aspet of the femoral artery and then oursing superfiial to femoral vein was found. The lateral irumflex femoral artery on the right was absent in Down's syndrome female adaver, but all its branhes were present and were arising from the profunda. We also observed a very rare variation of lateral irumflex femoral artery arising from the external ilia artery. The medial irumflex femoral artery originated at a higher level from the profunda as ompared to the lateral irumflex femoral artery. The inidene of medial irumflex femoral artery arising from the femoral artery was higher than that of lateral irumflex femoral artery. Variations in the arterial patterns may be due to the divergene in the mode and proximodistal level of branhing or aberrant vessels that onnet with the prinipal vessels, arades or plexuses during the development of the blood vessels. Thus the knowledge of these variations an be of great help to the surgeons in reduing the hanes of intraoperative seondary haemorrhage and postoperative ompliations. Copyright 00 BioMedSiDiret Publiations IJBMR ISSN: 097:85. All rights reserved.. Introdution Years after the advent of highly advaned imaging tehniques, arteriography still remains the main line of investigation in peripheral olusive arterial diseases. Peripheral angiograms are used to evaluate peripheral olusive arterial diseases, suspeted ongenital vasular anomalies, arterial status in trauma, imaging of * Corresponding Author : Daksha Dixit Professor, Department of Anatomy, KLE University's Jawaharlal Nehru Medial College, Nehrunagar, Belgaum 59000, Karnataka, India Phone No E mail : daksha97@gmail.om vasular malignanies, demonstration of the vasularity of malignanies and for identifying diseases inherent to the arterial system. The femoral artery is easily aessible to atheterisation. The profunda is used for arteriography, ultrasound and doppler imaging, digital subtration angiography and magneti resonane imaging. In the reent era, profunda femoris is being used for haemodialysis other than femoral artery and also the branhes of profunda femoris are used in anterolateral perforator thigh flap as long vasular pedile during breast reonstrution after mastetomy in ases of arinoma of breast []. Copyright 00 BioMedSiDiret Publiations. All rights reserved.

2 085 The profunda emerges from the posterolateral aspet of the femoral artery in the femoral triangle approximately 5 ms below the inguinal ligament []. This is the main artery whih supplies the addutor, extensor and flexor musles of the thigh. The branhes of profunda are medial and lateral irumflex femoral arteries and four perforating arteries []. Figure : Profunda arising from the medial aspet of femoral artery and oursing superfiial to the femoral vein. Also lateral irumflex femoral artery is arising from the femoral artery superior to the origin of profunda. (FV femoral vein, PFA profunda femoris artery, FA femoral artery, LCF lateral irumflex femoral artery.) The expanding sope of interventional radiology has prompted this study on the variations in the origin of profunda and its irumflex branhes.. Materials and Methods The materials used for this study were 0, 5 and 0 adavers from the Departments of Anatomy of J. N. Medial College, Belgaum, M. P. Shah Medial College, Jamnagar and Government Medial College, Bhavnagar, respetively. This study was done simultaneously at all the Medial Colleges using the same methods of study and data olletion. In all the Medial Colleges total of adavers and 8 femoral triangles were disseted as follows: the skin from the front of thigh was inised and refleted followed by the superfiial fasia. The great saphenous vein and superfiial inguinal lymph nodes were identified and the fasia lata was inised thus exposing the femoral triangle. The inguinal anal along with the inguinal ligament were identified, so were the addutor longus and sartorius musles. The femoral sheath was identified and its ompartments were disseted thus learing the femoral artery and its major branhes. The profunda femoris artery with its medial and lateral irumflex femoral branhes were disseted and identified. Their origin and ourses were studied. The relation of profunda at its origin to the femoral artery was studied. The distane of the site of origin of profunda from the midpoint of the inguinal ligament was measured in mm with a sale and vernier allipers and reorded. The site of origin of medial and lateral irumflex femoral arteries were studied and the distane of their site of origin from the origin of profunda was measured and reorded. The diameter of profunda near its origin from the femoral artery was measured in mm with the help of vernier allipers and reorded.. Results A total of 8 femoral triangles were disseted and the observations of various parameters are as follows:.site of origin of profunda : in the total of 8 lower limbs the profunda femoris originated from the posterolateral aspet of femoral artery in 9 ases i.e..%, from the posterior aspet in 8 ases i.e. 8.5%, from lateral in ases i.e. 8.8% and from the medial in 9 ases i.e. 0.5%. The profunda whih originates from the medial or posterior aspet of the femoral artery may ourse superfiial to the femoral vein. This type of variation was found in 5 ases (Fig. )..Distane of origin of profunda from the midpoint of the inguinal ligament: the distane of origin of profunda from the midpoint of the inguinal ligament on the right was most ommonly between 0 mm whereas on the left it was between 50 mm (Table ). Table : Distane origin of profunda from the midpoint of the inguinal ligament. No. of ases on Right Distane (mms) No. of ases on Left >80.0.Site of origin of lateral irumflex femoral artery: the origin of lateral irumflex femoral artery on the right was from profunda femoris artey in 7.8% (8 ases), from femoral artery as a ommon stem with profunda in 7.5% (0 ases), from femoral artery superior to profunda in 5.% ( ases), from femoral artery inferior to profunda in.% ( ases) and from external ilia artery 0.8% ( ase) whih is

3 08 a very rare variation. In Down's syndrome female adaver, the lateral irumflex femoral artery was absent and its branhes were diretly oming from the profunda (Fig. ). There was no double lateral irumflex femoral artery found. Figure : Lateral irumflex femoral artery is absent and its branhes; asending, desending and transverse are arising from the profunda. (FV femoral vein, PFA profunda, FA femoral artery.). On the left the lateral irumflex femoral artery was taking origin from profunda in 77.% (88 ases), from femoral artery as a ommon stem with profunda in.9% (7 ases) (Fig. ), from femoral artery superior to profunda in 5.% ( ases) and from femoral artery inferior to profunda in.% ( ases) (Table ). Table : Site of origin of lateral irumflex femoral artery Site of origin Perentage No. of Perentage ases on Left From profunda lateral aspet as a ommon stem with profunda superior to profunda inferior to profunda.. From external ilia artery 0.8 Absent lateral irumflex femoral artery 0.8. Distane of origin of lateral irumflex femoral artery from the origin of profunda on both the s was reorded in mm and was most ommonly between 0 mm (Table ). Table : Distane of origin of lateral irumflex femoral artery from the origin of profunda. Distane (mms) Figure : Lateral irumflex femoral artery arising from femoral artery as a ommon stem with profunda. (FV femoral vein, PFA profunda, FA femoral artery, LCF lateral irumflex femoral artery.) No. of ases on Right No. of ases on Right No. of ases on Left Site of origin medial irumflex femoral artery: on the right the medial irumflex femoral artery originated from the medial aspet of profunda in 5.% ( ases), from the femoral artery as a ommon stem with profunda in.% (9 ases), from femoral artery superior to profunda in 8.% ( ases) and from femoral artery inferior to profunda in 8.7% (0 ases).

4 087 On the left the origin of medial irumflex femoral artery was from the medial aspet of profunda in.7% (7 ases), from the femoral artery as a ommon stem with profunda in % ( ases) (Fig. ), from femoral artery superior to profunda in.9% (7 ases) and from femoral artery inferior to profunda in.% (5 ases) (Table ). Out of the total 8 ases, in ases the medial irumflex femoral artery originated from either profunda femoris artery or femoral artery and oursed superfiial to the femoral vein (Fig. 5). Figure 5: Medial irumflex femoral artery is arising from femoral artery and oursing superfiial to femoral vein. (FV femoral vein, PFA profunda, FA femoral artery, MCF medial irumflex femoral artery.) Figure : Medial irumflex femoral artery arising from femoral artery as a ommon stem with profunda and lateral irumflex femoral artery. (FV femoral vein, MCF medial irumflex femoral artery, PFA profunda, FA femoral artery, LCF lateral irumflex femoral artery.). Distane of origin of medial irumflex femoral artery from the origin of profunda was between 00 mm on both the s (Table 5). Table 5: Distane of origin of medial irumflex femoral artery from the origin of profunda. Distane (mms) Table : Site of origin of medial irumflex femoral artery. Site of origin No. of ases on Right Perentage No. of Perentage ases on Left From profunda lateral aspet as a ommon stem with profunda 9..0 superior to profunda inferior to profunda No. of ases on Right No. of ases on Left Figure : Profunda arising from the lateral aspet of femoral artery at a higher level. (FV femoral vein, MCF medial irumflex femoral artery, PFA profunda, FA femoral artery, LCF lateral irumflex femoral artery.)

5 088.7 Diameter of profunda : in our study the normal range of the diameter of profunda was 8 mm. In 5 ases the profunda was unduly large, the size being 0 mm and in ases the size was very small and between mm.. Disussion The knowledge of the site of origin of profunda is important while performing linial proedures in the femoral region and hip joint replaement and also for avoiding iatrogeni arteriovenous fistula or severe seondary haemorrhage while performing femoral artery punture. The most ommon site of origin of profunda is posterolateral aspet of femoral artery [, ]. In our study also the profunda originated from posterolateral aspet of femoral artery in 9 lower limbs i.e. in. % of ases. This is similar to 8% whih was reorded by Lippert H and Pabst R [5]. In 8.5% of ases (5 limbs) the profunda originated from the posterior aspet of femoral artery. In our study we had 89 ases (9%) wherein the profunda femoris artery was arising either from medial or posterior aspet of femoral artery. Out of these, 5 ases were suh that the profunda was oursing superfiial to the femoral vein, thus forming an arterial irle around the saphenofemoral juntion. Suh type of variation arries a risk of damage to the large and unexpeted arterial hannel while olleting blood in infants from femoral vein and during exposure of saphenous vein for ligation at its juntion with the femoral vein. The normal distane of origin of profunda from the midpoint of inguinal ligament is 50 mm []. In our study this distane was between 0 mm on right and between 50 mm on the left. We had ases, one on either, in two different adavers, where the profunda originated at a higher level between 00 mm (Fig. ). The advantage of suh a high origin of profunda is that it an be used for atheterisation and further investigation of any arterial system of the body. The ommonest site of origin of lateral irumflex femoral artery bilaterally was from the lateral aspet of profunda i.e. in 7.8% ases on the right and in 77.% ases on the left. Baptist M et al have also reported the origin of lateral irumflex femoral artery from the femoral artery []. Tanyeli E et al reported the origin of lateral irumflex femoral artery from the femoral artery inferior to the profunda femoris artey [7]. Uzel M et al studied 0 inguinal regions and found lateral irumflex femoral artery arising from profunda in 85 ases (77.%) and from femoral artery inluding ommon stem in 5 ases (.7%) [8]. Fukuda H et al in 005 reported 78.% ases wherein lateral irumflex femoral artery originated from the profunda femoris artery and.% ases wherein it originated from femoral artery inluding ommon stem [9]. These findings are similar and omparable to our findings. In our study we found ase on the right, wherein the lateral irumflex femoral artery was arising from external ilia artery. In most of our ases the distane of origin of lateral irumflex femoral artery from the origin of profunda was between 0 mm. In of our ases the lateral irumflex femoral artery was absent on the right in a 5 year old female adaver having Down's syndrome. The branhes of lateral irumflex femoral artery i.e. asending, desending and transverse were present and arose diretly from profunda. On the left of this adaver the lateral irumflex femoral artery was present and originated from the profunda. The medial irumflex femoral artery mostly originated from the medial aspet of profunda on both the s i.e. in 5.% ases on right and in.7% ases on the left. This is omparable to 59% found by Lipshutz BB in 9, % found by Siddharth P et al in 985, 5% reported by Clarke SM and Colborn GL in 99 and 7.% reported by Prakash et al in 00 [0,,, ]. The distane of origin of medial irumflex femoral artery from the origin of profunda was mostly between 00 mm on both the s. Thus the medial irumflex femoral artery originated at a higher level from the profunda as ompared to lateral irumflex femoral artery. Evans CA et al found both medial and lateral irumflex femoral arteries arising by a ommon trunk from the femoral artery []. Bergman RA et al in 99 observed 00 limbs out of whih in ases both the lateral and medial irumflex femoral arteries originated from profunda femoris artery. Out of the remaining ases the medial irumflex femoral artery was arising from femoral artery in ases and lateral irumflex femoral artery was arising from femoral artery in 9 ases [5]. In our study also out of the total 8 limbs, the medial irumflex femoral artery in 5 ases was arising from femoral artery while the lateral irumflex femoral artery was arising from femoral artery in only 8 ases. Thus it means that the inidene of medial irumflex femoral artery arising from femoral artery is higher than that of lateral irumflex femoral artery. The origins of medial and lateral irumflex femoral arteries diretly from the femoral artery is assoiated with distal shift of the level of separation of the profunda from the femoral artery []. 5. Conlusion Aording to our study the most ommon site of origin of profunda was from the posterolateral aspet of the femoral artery. A rare variation was observed in 5 ases wherein the profunda arose from either posterior or medial aspet of the femoral artery and then oursed superfiial to femoral vein. This is of great surgial importane as suh a large and unexpeted arterial hannel an be damaged while olleting blood in infants from femoral vein or during exposure of saphenous vein for ligation at its juntion with the femoral vein. The lateral irumflex femoral artery was absent in Down's syndrome female adaver on the right but all its branhes were present and were arising from the profunda. We also observed a very rare variation of lateral irumflex femoral artery arising from the external ilia artery in lower limb. Sahin B et al in 00 attributed suh a variation to the different ramifiation patterns during the development of the vasulature of the lower limb []. In our study the medial irumflex femoral artery originated at a higher level from the profunda as ompared to the lateral irumflex femoral artery. We also found that the inidene of medial irumflex femoral artery arising from the femoral artery was higher than that of lateral irumflex femoral artery. The development of the vasulature in the lower limb preedes the morphologial and moleular hanges that our in the limb mesenhyme, hene vasular variations are more of a rule than an exeption [7]. Anomalous patterns of vasular system may be due to: divergene in the mode and proximodistal level of branhing; presene of unusual ompound arterial segments; aberrant vessels that onnet with the prinipal vessels, arades or plexuses; and vessels oupying exeptional tissue planes and having unsuspeted neural, myologial or osteoligamentous relationships [, 8]. A thorough knowledge of the normal anatomy and variations of the site of origin and ourse of the profunda and its irumflex branhes is not only of paramount surgial importane during vasular diagnosti interventional proedures and surgeries but also helps in reduing the hanes of intraoperative seondary haemorrhage and postoperative ompliations. Needless to say, that the aforementioned anatomial fats should be onred before planning different diagnosti and therapeuti proedures on the femoral artery and its branhes. Aknowledgements The authors are highly grateful to KLE University's J. N. Medial College, Belgaum; M. P. Shah Medial College, Jamnagar; and Government Medial College, Bhavnagar, for providing the neessary support and infrastruture failities for arrying out the present study.. Referenes [] Kaplan JL, Allen RJ. A ost based omparison between perforator flaps and TRAM flaps. Plast Reonstr Surg 000: 05(): 998.

6 089 [] Hollinshead HW. Buttok, Hip joint and thigh, Profunda. In: Anatomy for surgeons: Vol.. The bak and limbs. nd ed. Hoeber Medial Division, Happer & Row Publishers, New York, Evanston and London, 99, pp [] Standring S. Pelvi girdle, Gluteal region and hip joint, Profunda femoris artery. In: Gray's Anatomy, The anatomial basis of linial pratie. 0th ed. Elsevier Churhill Livingstone, 008, pp [] Sahana. Cirulatory system, Profunda In: Human Anatomy st ed. The Central Book Ageny, Calutta, India, 9, pp 5. [5] Lippert H, Pabst R. Arterial variation in man, lassifiation and frequeny. J F BergmannVerlag N Munhe 985; 0. [] Baptist M, Sultana F, Hussain T. Anatomial variation of the origin of profunda, its branhes and diameter of the femoral artery. Professional Med J 007; (): 557. [7] Tanyeli E, Yildirim M, Uzel M, Ural F. Deep femoral artery with variations a ase report. Surg Radiol Anat 00; 8():. [8] Uzel M, Tanyeli E, Yildirim M. Anatomial study of the origin of lateral irumflex femoral artery in Turkish population. Folia Morphol (Warsz) 008; 7(): 0. [9] Fukuda H, Ashida M, Ishii R, Abe S, Ibukuro K. Anatomial variants of the lateral femoral irumflex artery: an angiographi study. Surg Radiol Anat 005; 7(): 0. [0] Liphutz BB. Studies on the blood vasular tree,, A omposite study of the femoral artery. Anat Re 9; 0: 70. [] Siddharth P, Smith NL, Mason RA, Giron F. Variational anatomy of the deep femoral artery. Anat Re 985; (): 009. [] Clark SM, Colborn GL. The medial femoral artery: its linial anatomy and nomenlature. Clin Anat 99; (): 905. [] Prakash, Jyoti K, Bhardwaj AK, Jose BA, Yaday SK, Singh G. Variations in the origins of the profunda femoris, medial and lateral femoral irumflex arteries: a adaveri study in Indian population. Rom J Morphol Embryol 00; 5(): 770. [] Evans CA, Smith KS, Jarolim L. Observations of unommon variations of proximal branhes of femoral artery. Faseb J 007; 77.. [5] Bergman RA, Afifi AK, Miyayihi R. Compendium of human anatomi variations. Urban & Shwarzenberg, BaltimoreMunih 988, pp 887. [] Sahin B, Vazun A, Emirzeoglu M, Kosif R, Bilgi S. A deep femoral artery passing in front of the femoral vein. Foila Morphol (Warsz) 00; ():. [7] Keen JA. A study of the arterial variations in the limbs with speial referene to symmetry of vasular patterns. Am J Anat 9; 5. [8] Balahandra N, Prakash BS, Padmalatha K, Ramesh BR. Variation in the origin of the lateral irumflex femoral artery a ase report. Anatomia Karnataka 0; 5: 780. Copyright 00 BioMedSiDiret Publiations IJBMR ISSN: 097:85. All rights reserved.