Henry Gray (18251861). Anatomy of the Human Body. 1918.
from 2 to 5 cm. below the inguinal ligament. At first it lies lateral to the femoral artery; it then runs behind it and the femoral vein to the medial side of the femur, and, passing downward behind the Adductor longus, ends at the lower third of the thigh in a small branch, which pierces the Adductor magnus, and is distributed on the back of the thigh to the hamstring muscles. The terminal part of the profunda is sometimes named the fourth perforating artery.
Relations.Behind it, from above downward, are the Iliacus, Pectineus, Adductor brevis, and Adductor magnus. In front it is separated from the femoral artery by the femoral and profunda veins above and by the Adductor longus below. Laterally, the origin of the Vastus medialis intervenes between it and the femur.
Peculiarities.This vessel sometimes arises from the medial side, and, more rarely, from the back of the femoral artery; but a more important peculiarity, from a surgical point of view, is that relating to the height at which the vessel arises. In three-fourths of a large number of cases it arose from 2.25 to 5 cm. below the inguinal ligament; in a few cases the distance was less than 2.25 cm.; more rarely, opposite the ligament; and in one case above the inguinal ligament, from the external iliac. Occasionally the distance between the origin of the vessel and the inguinal ligament exceeds 5 cm.
Branches.The profunda gives off the following branches:
Lateral Femoral Circumflex.
Medial Femoral Circumflex.
The Lateral Femoral Circumflex Artery (a. circumflexa femoris lateralis; external circumflex artery) arises from the lateral side of the profunda, passes horizontally between the divisions of the femoral nerve, and behind the Sartorius and Rectus femoris, and divides into ascending, transverse, and descending branches.
The ascending branch passes upward, beneath the Tensor fasciæ latæ, to the lateral aspect of the hip, and anastomoses with the terminal branches of the superior gluteal and deep iliac circumflex arteries.
The descending branch runs downward, behind the Rectus femoris, upon the Vastus lateralis, to which it gives offsets; one long branch descends in the muscle as far as the knee, and anastomoses with the superior lateral genicular branch of the popliteal artery. It is accompanied by the branch of the femoral nerve to the Vastus lateralis.
The transverse branch, the smallest, passes lateralward over the Vastus intermedius, pierces the Vastus lateralis, and winds around the femur, just below the greater trochanter, anastomosing on the back of the thigh with the medial femoral circumflex, inferior gluteal, and first perforating arteries.
The Medial Femoral Circumflex Artery (a. circumflexa femoris medialis; internal circumflex artery) arises from the medial and posterior aspect of the profunda, and winds around the medial side of the femur, passing first between the Pectineus and Psoas major, and then between the Obturator externus and the Adductor brevis. At the upper border of the Adductor brevis it gives off two branches: one is distributed to the Adductores, the Gracilis, and Obturator externus, and anastomoses with the obturator artery; the other descends beneath the Adductor brevis, to supply it and the Adductor magnus; the continuation of the vessel passes backward and divides into superficial, deep, and acetabular branches. The superficial branch appears between the Quadratus femoris and upper border of the Adductor magnus, and anastomoses with the inferior gluteal, lateral femoral circumflex, and first perforating arteries (crucial anastomosis). The deep branch runs obliquely upward upon the tendon of the Obturator externus and in front of the Quadratus femoris toward the trochanteric fossa, where it anastomoses with twigs from the gluteal arteries. The acetabular brancharises opposite the acetabular notch and enters the hip-joint beneath the transverse ligament in company with an articular branch from the obturator artery; it supplies the fat in the bottom of the acetabulum, and is continued along the round ligament to the head of the femur.