 Good day everybody. Dr. Sanjay Sanyal, Professor Department Chair. This is going to be a demonstration of the femoral artery in its branches and the profundum femoris artery. This is a supine cadaver. This is the left side of the cadaver. I'm standing on the left side. The camera person is on the left side. Just to bring up to speed, we have opened out the left thigh, anterior aspect. This is the sartorius muscle. This is the rectus femoris. This is the vestus lateralis. Vastus intermedius. This is the vestus medialis. This whole thing. This is the adductor longus. Under that we have this muscle here. This is the adductor magnus. And if you were to trace, this is the tendon of the adductor magnus that we can see here, which is called the adductor tendon. This is the hamstring component of the adductor magnus. So therefore this portion is the adductor component. This is the hamstring component. This is the adductor brevis. This is the iliosoas. And we can see the femoral nerve running on the iliosoas. But we shall be focusing on the femoral artery and the femoral vein. But before I go to that, I just want to bring your attention to the nerve supply of the adductor muscles. If you take a close look between the adductor magnus and the adductor brevis, we can see this nerve here. This is the operator nerve. And we can clearly see it is giving numerous branches to the adductor compartment. It's giving branches to that olongus, magnus, and brevis. It also gives branches to the gracilis. Now we shall move to the inner aspect of the pelvis. And we can see the operator nerve here in the pelvis. And I'm going to lift it up. This is the operator nerve in the pelvis. It rises from the adductor division of L2-3-4. And it passes through the operator canal. And it enters into the thigh. And we can see when I'm exerting traction here, this nerve is moving here. So this is the operator nerve. Now let's come to the femoral artery in the femoral vein. This is the femoral artery. And this is the femoral vein. They were all enclosed in a sheath called the femoral sheath, which is derived from the iliosoas fascia and the fascia transversalis of the abdomen. And we have removed the sheath. The course of the femoral artery is from the mid-enguinal point to the adductor hiatus. So let's take a look at the mid-enguinal point. It is not the same as the midpoint of the inguinal ligament. This is the inguinal ligament that we have lifted up here. We can see that the femoral artery is coming in the sub-enguinal space. And this space is referred to as the vascular compartment because the blood vessels are located here. And it is the continuation of the external iliac artery and the external iliac vein which we have lifted up here. So the mid-enguinal point is midpoint between the anterior superior iliac spine and the pubic symphysis. The midpoint of that and one inch below that is the location of the femoral artery. The femoral artery then descends down to the thigh and it becomes a popliteal artery here. If we were to look on the medial side, we can see a tendinous structure here. This is the adductor tendon as I mentioned a little while back and just medial to that. There is an opening and my finger has gone into that opening. That is called the adductor hiatus. And that places the location where the femoral artery becomes a popliteal artery. So this where my fingers are located, this is the course of the femoral artery and this is how we draw the surface marking of the femoral artery. Now let's take a look at the branches of the femoral artery. We can see this branch here. This is the superficial circumflex iliac artery which goes around the iliac bone. There should be a branch which runs like this towards the abdomen which we have removed. That is called the superficial epigastric. And finally, one branch runs towards the genitalia that is known as the external pudendal which supplies the skin and the superficial fascia, the dartos fascia of the penis. So these are the three small branches and after that, the femoral artery gives this huge branch and we can see that. This is the profundum femoris artery or the deep artery of the thigh. And we can see in certain situations the femoral artery is almost as big or even bigger than the main femoral artery. We shall tell you about the branches of the femoral artery just now. To continue, the femoral artery in the femoral triangle is located lateral to the femoral vein. And then as it descends down, it enters the canal here. And that canal is referred to as the adductor canal or the sub-sartorial canal. This adductor canal is bounded by the sartorials medially. The vastus medial is laterally and posteriorly it is bounded by the adductor longus. And it is pitched over by a fascia called the sub-sartorial fascia which we have split open. And in the adductor canal, the relationship is like this. Anteriorly is this nerve here, this is the subvenous nerve. Middle is the femoral artery and posterior is the femoral vein. So these are the three structures which run through the adductor canal. And now my finger has gone into the adductor canal. And this adductor canal then ends in the hiatus which I mentioned earlier called the adductor hiatus where the femoral artery in the vein becomes the femoral artery and vein. So this is the full course of the femoral artery. Now let's come back to the profunda femoris. The profunda femoris as the term implies is an artery which goes deep inside the thigh. The profunda femoris, as it comes out, it gives these two branches and we can see that here. This is the lateral circumflex femoral. And going, this is the medial circumflex femoral. The medial circumflex femoral is the one which goes on the medial side of the neck of the femoral and it gives multiple retinocular arteries to the neck and to the head of the femur. They run in the retinocular spaces of the synovial folds. The lateral circumflex and the medial circumflex artery, the anastomers around the greater trochanter. And here they are also accompanied by the first perforating artery and a branch from the inferior gluteal artery. And they produce what is known as the cruciate anastomosis around the greater trochanter. And this cruciate anastomosis is the important collateral circulation in iliofemoral occlusion. So these are the first two branches. And thereafter, the main profunda femoris, as we can see, it runs deep inside. And this is the place where it is running and we can see it here. And we can see this is the profunda femoris vein. Both of them run deep and they run between this muscle, which I mentioned. This is the vastus medialis and this muscle, the rector magnus. So it runs close to the insertion of the rector magnus to the linea aspera and close to the origin of the vastus medialis to the linea aspera. It runs between these two muscles. And here, as it runs along the insertion of the rector magnus, it gives four perforating arteries, which we cannot see properly in this view, in this dissection, because this is from the anterior aspect. And I shall show it to you in a posterior view in another cadaver. So this is the full course of the profunda femoris artery. Now let's mention a few important clinical correlations. This femoral artery is a very useful route for various angiograms. It is usually palpated here, just below the Kingwai ligament against the superior ramus of the pubis. And this is where we feel the femoral pulse and we can cannulate it and we can go through the external iliac artery, the common iliac artery, the abdominal aorta, and we can do various angiograms in pheromocentric, superior mocentric, celiac, renal angiogram, and we can go right up to the coronary circulation and we can do coronary angiogram, do their other routes also. At the same time, we can also do a femoral-publican angiogram, as shown in this view. So this is one important use of the femoral artery. We can use the femoral artery as a guide to do any puncture of the femoral vein for cardiac catheterization because we know that the femoral vein is located just medium to the femoral artery. So this is another important use of the femoral artery. Finally, when we want to do a knee surgery or any surgery on the anterior aspect of the thigh, it may sometimes be necessary to give a femoral nerve block. So how to locate the femoral nerve? We use the position of the femoral artery as our guide. And using this, we know that the femoral nerve is located about an inch lateral to the femoral artery. And that's how we keep a femoral nerve block in the femoral triangle before any knee surgery. So therefore, these are some clinical uses of the femoral artery in the thigh. More will follow when we come to the others. Canever, we will see the branches of the profound of femoris in the posterior aspect and the continuation of the femoral artery, namely the pubillary artery. So that's all for now. Dr. Sanjay Sanyal signing out. David, who is the camera person. Thank you very much for watching. If you have any questions or comments, please put them in the comment section below. Have a nice day.