Artera femurală

Ligamentul inighinal Poupart este o banda fibroasa dura care se intinde de la spina iliaca antero-
superioara la tuberculul pubian. Artera femurala comuna este continuarea arterei iliace externe, si
incepe sub jumatatea ligamentului inghinal. Se palpeaza ca si puls femoral si este potrivita pentru acces
percutanat si chirugical

La aproximativ 2.5-5 cm. distal de ligamentul inghinal artera femurala se divide in artera femurala
profunda cu traiect postero-lateral si artera femurala superficiala. Artera femurala da ramuri proximale
care mentin circulatia si in caz de boala ateroslcerotica extinsa, avand rol major in circulatia colaterala in
cazul unei artere femurale superficiale ocluzate

Termenul de artera femurala superficiala este impropriu deoarece aceasta are un traiect superficial de
cativa centimetrii pana cand ajunge sub Sartorius si in aponevroza ce acopere canalul adductor Hunter.
Cand artere femurala superficiala paraseste cananlul adductor, devine artera poplitee

Artera poplitee
Artera poplitee prezinta anumite caracteristici distincte embriologice si anatomice spre deosebire de
artera femurala. Embryologic Artera poplitee are originea in sistemul sciatic. Artera poplitee este
pozitionata in fosa poplitee. A. femurala superficiala devine poplitee la trecerea prin hiatul adductor si isi
continua traiectul pana se bifurca in A. tibiala anterioara si trunchiul tibioperonial. Artera poplitee este
localiazata intre cele 2 capete ale gastrocnemianului, posterior de femurul distal si anterior de vena
poplitee. Datorita proximitatii anatomice de femurul distal si gastrocnemian Artera poplitee este
susceptibila la leziuni in timpul unei fracture femurale sau dislocatii a genunchiului sau a sindromului de
compartiment. Spre deosebire de artera femurala superficiala, Artera poplitee nu e localizata intr-un
compartiment muscular si e supusa unor forte biomecanice de torsiune legate de flexia si extensia
genunchiului. Aceasta regiune anatomica este caracterizata de un stress biomecanic ridicat cu
consecinte negative in cazul un procedure ca bypass-ul sau limitarea tehnicilor endovasculare de
stenting. Stresul biomecanic poate duce la fracture ale stentului.

La nivelul genunchiului artera popliteala da ca si ramuri artera geniculate si surala. Deasupra

genunchiului da artera superioara laterala si superioara medial geniculate. Sub genunchi da artera
inferioara laterala si medial geniculate. Toate aceste ramuri alcatuiesc o retea bogata intre artera
femurala superficiala, profunda si arterele tibiala. Aceasta retea colaterala are un rol essential in
leziunile cornice ocluzive a arterei popliteale.

Artera tibială anterioară

Ramura a arterei poplitee, pleaca de la inelul tendinos as solearului, strabate superior spatial interosos si
coboara pe fata anterioara a tibiei, pana la ligamentul cruciat unde se continua cu artera pedioasa. Da
ramuri colaterala pentru reteaua articulara a genunchiului si ramuri musculare pentru muschii regiunilor
anterioara, laterala si inferioara a gambei, formand o retea maleolara externa si interna

Artera tibială posterioară

Continua traiectul arterei poplitee, incepe de la nivelul inelului tendinos al solearului si trece pe partea
postero-interna a gambei pana la santul retromaleolar intern unde se bifurca formand arterele plantare.
Da artera peroniera in traiectul ei, care merge pe partea postero-externa a gambei pana la maleola
externa, unde da ramuri calcaneene larerala. Artera peroniera da: artera nutritive a peronierului si a
tibiei, ramuri pentru muschii din regiunea posterioara a gambei.

Artera pedioasă
Artera pedioasa sau artera dorsala a piciorului, ramura terminal a tibialei anterioara. Da la nivelul
primului spatiu interosos artera interosoasa dorsala 1 si artera plantara profunda ce ajunge la planta. Pe
traiecte da ca si colaterale artera externa a tarsului terminate prin artera interosoasa dorsala 5, artera
arcuata din care pornsesc arterele interosoase 2,3,4. Aceste doua colaterale si anastomozeaza intre ele.
Din cele 5 artere interosoase pornesc artere digitale dorsale. Ramuri din artera dorsala a piciorului, din
artera externa a tarsului so din artera arcuata se anastomozeaza formand reteaua dorsala a piciorului

https://emedicine.medscape.com/article/461910-
overview?src=refgatesrc1#showall

Anatomy
The popliteal artery is characterized by distinct embryologic and anatomic
features as compared with the femoral vessels. Embryologically, unlike the
superficial femoral artery, the popliteal artery originates from the sciatic
system. [1]
The popliteal artery sits on the posterior aspect of the leg, in the popliteal
fossa. The superficial femoral artery becomes the popliteal artery as it passes
through the adductor hiatus, and it proceeds until it bifurcates into the anterior
tibial artery and the tibioperoneal trunk.
The tibioperoneal trunk divides into the posterior tibial and peroneal arteries.
The popliteal artery is located between the two heads of the gastrocnemius. It
lies posterior to the distal femur and anterior to the popliteal vein. The
anatomic proximity of the popliteal artery to the distal femur and
gastrocnemius makes this artery susceptible to injury during femoral fracture
or knee dislocation and entrapment syndrome, respectively.
Compared with the superficial femoral artery, the popliteal artery is not located
within the muscular compartment and is subjected to significant
biomechanical torsional forces related to the repetitive knee flexion and
extension. [2, 3, 4] This anatomic region is characterized by a high biomechanical
stress, which consequently negatively affects patency rates associated with
the popliteal artery bypass procedures and imposes technical limitations on
endovascular stenting, in that biomechanical stress may lead to stent
fractures.
At the level of the knee, the popliteal artery gives off genicular and sural
branches. Above the knee joint, it gives off the superior lateral and the
superior medial genicular arteries. Below the knee, it gives off the inferior
lateral and the inferior medial genicular arteries. These branches provide a
rich network between the superficial femoral artery, the deep femoral
(profunda femoris) artery, and the tibial arteries. This collateral circulation is
very important in the presence of chronic occlusive disease of the popliteal
artery.

https://emedicine.medscape.com/article/460965-overview#showall
Anatomy
The inguinal (Poupart) ligament is a tough, fibrous band stretching from the
anterior superior iliac spine to the pubic tubercle. The common femoral artery
is a continuation of the external iliac artery, beginning just under the middle of
the inguinal ligament. It is palpable as the femoral pulse and is well suited to
both percutaneous and surgical access because of its relatively superficial
position.
Approximately 2.5-5.0 cm distal to the inguinal ligament, the common femoral
artery divides into the deep femoral (profunda femoris) artery, usually arising
in the posterolateral position, and the superficial femoral artery.
The deep femoral artery gives rise to several very proximal branches that tend
to maintain patency even in persons with extensive atherosclerotic disease,
thus providing the major source of collateral circulation around an occluded
superficial femoral artery.
The term superficial femoral artery is somewhat of a misnomer, in that it is
superficial for only a few inches until it courses under the sartorius and into
the aponeurotic covering of the adductor (Hunter) canal.
When the superficial femoral artery emerges anterior to the adductor magnus,
it becomes the popliteal artery. Because the popliteal artery is bounded
posteriorly by the popliteal vein, nerve, and fascia and the semimembranosus,
gastrocnemius, plantaris, and soleus muscles, it is the most difficult of the
lower-extremity pulses to assess accurately.
The popliteal artery passes posterior to the knee joint and into the upper leg
where, just distal to the popliteus, it divides into the anterior tibial artery and
the tibioperoneal trunk.
The anterior tibial artery passes laterally through the interosseous membrane
and lies on the interosseous membrane throughout much of the leg. As it
reaches the lower leg, it lies on the tibia and then becomes superficial at the
ankle joint, at which point it is called the dorsalis pedis artery and, hence, is
palpable as the dorsalis pedis pulse.
The tibioperoneal trunk divides within approximately 2.5 cm of its origin into
the peroneal artery and the posterior tibial artery.
The peroneal artery lies on the medial surface of the fibula and ends in
terminal branches near the os calcis. The peroneal artery, which is too deep
to be palpable as a pulse, often remains patent despite atherosclerotic
occlusion of the anterior and posterior tibial arteries and, thus, may be a
usable site for the distal anastomosis of bypass grafts in patients with
advanced infrapopliteal occlusive disease.
The posterior tibial artery runs along the medial side of the leg and posterior to
the medial malleolus, where it is superficial and palpable as the posterior tibial
pulse.
The great (long) saphenous vein originates on the medial side of the dorsum
of the foot and runs anterior to the medial malleolus. It then runs
posteromedially to the tibia, posteriorly to the medial condyle of the femur, and
along the medial thigh, coursing anteriorly until it enters the femoral vein
through the foramen ovale, just below the inguinal ligament. The length and
relatively superficial course of the great saphenous vein make it ideally suited
for use in infrainguinal bypass surgery.

http://www.jvascsurg.org/article/S0741-5214(10)00237-5/fulltext bassil

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774259/ predator

Arterele sunt alcatuite din 3 straturi suprapuse.

De la exterior la interior aceste straturi sunt:
� adventicea
� tunica mijlocie sau media
� tunica interna sau intima

Intre aceste 3 straturi exista doua membrane elastice, care separa straturile: membrana elastica
interna separa intima de medie iar membrana elastica externa separa media de adventice.

Adventicea

Adventicea este alcatuita din tesut conjunctiv, care contine fibre de colagen si elastice. Adventicea
este vascularizata printr-o retea de vase mici de sange care formeaza vasa vasorum si care patrund si
in tunica medie.
De asemenea, in adventice se afla si fibre nervoase vegetative.

Tunica mijlocie (media)

Acest strat are o structura diferita in functie de calibrul arterelor.

Arterele mari, au o structura mai elastica, iar media este formata din lame elastice cu dispozitie
concentrica, mai putine fibre musculare si tesut conjunctiv.
Arterele de tip muscular sunt arterele mijlocii si mici. Acest strat contine numeroase fibre musculare
netede, printre care se afla fibre de colagen si elastice.

Tunica interna(intima)

Acest strat este unicelulare, formate din celule endoteliale, cu forma turtita, asezate pe o membrana
bazala.
La nivelul inimii, tunica interna se continua cu endocardul.