Popliteal arteries and veins. Device and blood supply of the knee joint. Surgical Solutions

femoral artery

femoral artery,a. femoralis, is a continuation of the external iliac artery, passes through the vascular lacuna lateral to the vein of the same name, goes down in the femoral triangle. Then the artery enters the adductor canal and leaves it on the back of the thigh in the popliteal fossa. Branches of the femoral artery: 1) superficial epigastric artery,a. epigastric superficialis, goes up, supplying the aponeurosis of the external oblique muscle of the abdomen, fiber and skin, anastomoses with the branches of the superior epigastric artery; 2) superficial circumflex artery of the iliuma. circumflexa ilium superficialis, goes to the anterior superior iliac spine, branches in the adjacent muscles and skin. 3) external pudendal arteries,aa. pudendae exterpae(2-3), go to the scrotum in men and to the labia majora in women; four) deep femoral artery,a. profunda femoris- the largest branch of the femoral artery - departs from it 3-4 cm below the inguinal ligament, supplies the thigh with blood. From the deep artery of the thigh, the medial and lateral arteries depart, enveloping the femur and perforating arteries. Medial circumflex artery of the femura. circumflexa femoris medialis, follows medially, bends around the femoral neck and gives branches to the muscles of the pelvic girdle and the hip joint. Lateral circumflex artery of the femura. circumflexa femoris lateralis, blood supply to the gluteus maximus muscle and the tensor fascia lata, as well as the thigh muscles (tailor and quadriceps). perforating arteries,aa. perforantes, in the amount of three they are sent to the back of the thigh, where they supply blood to the biceps, semitendinosus and semimembranosus muscles, anastomosing with the branches of the popliteal artery; 5) descending genicular artery, a. Genus descendens, takes part in the formation of the knee articular network.

popliteal artery, a. poplitea, is a continuation of the femoral artery. At the level of the lower edge of the popliteal muscle, this artery divides into terminal branches - the anterior and posterior tibial arteries. Branches of the popliteal artery: 1) lateral superior genicular artery,a. genus superior lateralis, blood supply to the lateral wide and biceps muscles of the thigh and anastomoses with other knee arteries; 2) medial superior genicular artery,a. genus superior medialis, blood supply to the medial broad muscle of the thigh; 3) middle knee artery,a. genus media, blood supply to the back wall of the capsule of the knee joint, cruciate ligaments and menisci; four) lateral inferior genicular artery,a. genus inferior lateralis, blood supply to the lateral head of the gastrocnemius muscle and plantar muscle; 5) medial inferior genicular artery,a. genus inferior medialis, blood supply to the medial head of the gastrocnemius muscle. All of these branches of the popliteal artery are involved in the formation of the knee articular network (rete articularis genus).

Rice. 793. Arteries of the gluteus medius, right (X-ray photograph. Preparation by N. Rybakina). (The largest vessels in the thickness of the muscle are presented.)

Popliteal artery, a. poplitea (Fig.,,,; see Fig.,,), is a direct continuation of the femoral artery. It starts at the level of the lower opening of the afferent canal, lies under the semimembranosus muscle and goes along the bottom of the popliteal fossa, adjoining first to the popliteal surface of the femur and then to the articular capsule of the knee joint, and in its lower section to the popliteal muscle. The popliteal artery has a direction first downward and somewhat laterally, and from the middle of the popliteal fossa it is almost vertical.

The popliteal artery is accompanied throughout the entire length by the vein of the same name and the tibial nerve, n. tibialis. On the side of the popliteal fossa, behind, the vein lies superficially, and the nerve is even more superficial in relation to the artery and vein.

In its course, the popliteal artery gives a number of branches that supply blood to the muscles and the knee joint. All these branches anastomose widely among themselves, as well as with rr. perforantes (branches a. profunda femoris) and a. descendens genicularis (branch a. femoralis), forming a dense vascular knee joint network (see Fig.).

A number of branches depart from the popliteal artery (see Fig.,).

Lateral superior genicular artery, a. superior lateralis genus, goes outwards under the biceps femoris and, heading over the lateral condyle, breaks up into smaller branches that take part in the formation of the knee articular network.
Medial superior genicular artery, a. superior medialis genus, goes anteriorly under the tendons of the semimembranosus and large adductor muscles, above the medial condyle and, bending around the femur from the inside, takes part in the formation of the knee articular network.
Middle genicular artery, a. media genus, goes anteriorly from the popliteal artery, pierces the capsule of the knee joint above the oblique popliteal ligament and gives a number of branches to the synovial membrane of the joint and the cruciate ligaments.
Lateral inferior genicular artery, a. inferior lateralis genus, starts from the most distal part of the popliteal artery, passes under the lateral head of the gastrocnemius muscle and the biceps femoris, goes around the knee joint above the head of the fibula and, having reached the anterior surface of the knee, takes part in the formation of the knee articular network.
Medial inferior genicular artery, a. inferior medialis genus, passes under the medial head of the gastrocnemius muscle and goes around the medial periphery of the knee joint, lying under the tibial collateral ligament. The branches of the artery are part of the network of the knee joint.
Sural arteries, aa. naturales, only two (sometimes more), depart from the posterior surface of the popliteal artery and, breaking up into a number of smaller branches, supply blood to the proximal sections of the triceps and plantar muscles of the lower leg and the skin of the lower leg.

Popliteal artery, a. poplitea, is a direct continuation of the femoral artery. It starts at the level of the lower opening of the afferent canal, lies under the semimembranosus muscle and goes along the bottom of the popliteal fossa, adjoining first to the popliteal surface of the femur and then to the articular capsule of the knee joint, and in its lower section to the popliteal muscle. The popliteal artery has a direction first downward and somewhat laterally, and from the middle of the popliteal fossa it is almost vertical.

The lower part of the artery passes into the gap between the heads of the gastrocnemius muscle covering it, and at the level of the lower edge of the popliteal muscle, the artery follows between it and the heads of the gastrocnemius muscle; under the edge of the soleus muscle is divided into the posterior tibial artery, a. tibialis posterior, and anterior tibial artery, a. tibialis anterior.

The popliteal artery is accompanied throughout the entire length by the vein of the same name and the tibial nerve, n. tibialis. On the side of the popliteal fossa, behind, the vein lies superficially, and the nerve is even more superficial in relation to the artery and vein.

1. Lateral superior genicular artery, a. superior lateralis genus, goes outwards under the biceps femoris and, heading over the lateral condyle, breaks up into smaller branches that take part in the formation of the knee articular network.

2. Medial superior genicular artery, a. superior medialis genus, goes anteriorly under the tendons of the semimembranosus and large adductor muscles, above the medial condyle and, bending around the femur from the inside, takes part in the formation of the knee articular network.
3. Middle knee artery, a. media genus, goes anteriorly from the popliteal artery, pierces the capsule of the knee joint above the oblique popliteal ligament and gives a number of branches to the synovial membrane of the joint and the cruciate ligaments.

4. Lateral inferior genicular artery, a. inferior lateralis genus, starts from the most distal part of the popliteal artery, passes under the lateral head of the gastrocnemius muscle and the biceps femoris, goes around the knee joint above the head of the fibula in, reaching the anterior surface of the knee, takes part in the formation of the knee articular network.

5. Medial inferior genicular artery, a. inferior medialis genus, passes under the medial head of the gastrocnemius muscle and goes around the medial periphery of the knee joint, lying under the tibial collateral ligament. The branches of the artery are part of the network of the knee joint.

6. Calf arteries, aa. surales, only two (sometimes more), depart from the posterior surface of the popliteal artery and, breaking up into a number of smaller branches, supply blood to the proximal sections of the triceps and plantar muscles of the lower leg and the skin of the lower leg.

Topography:

Popliteal artery, a. poplitea, lies in the popliteal fossa medially and deeper than the tibial nerve, closest to the femur.

Branches of the popliteal artery

In the popliteal fossa, the popliteal artery gives off muscular branches, as well as five genicular arteries.

Superior genicular arteries, lateral and medial

Middle knee artery, a. media genus (unpaired), it immediately goes forward and branches in the posterior wall of the capsule of the knee joint and in its cruciate ligaments.

Inferior genicular arteries, lateral and medial

All these arteries, except for the middle one, form deep and superficial arterial networks in the anterior region of the knee joint.

blood supply The knee joint is carried out by the branches of the popliteal artery, which form the knee articular network, the lateral and medial superior genicular arteries, the lateral and medial inferior genicular arteries, as well as the descending genicular, anterior and posterior tibial recurrent arteries.

Leg arteries: topography, branches and areas of blood supply. Ankle blood supply.

Leg arteries:

A. tibialis anterior, anterior tibial artery, is one of the two terminal branches of the popliteal artery.

Branches of the anterior tibial artery, a. tibialis anterior:

A. recurrens tibialis posterior, posterior recurrent tibial artery, to the knee joint and to the joint between the fibula and tibia.

A. recurrens tibialis anterior, anterior recurrent tibial artery

· Ah. malleolares anteriores medialis et lateralis, the anterior ankle arteries, lateral and medial, are involved in the formation of the medial and lateral ankle network.

A. tibialis posterior, posterior tibial artery, is a continuation of the popliteal artery.

a. peronea (fibularis), peroneal artery, departs from the posterior tibial artery and ends at the calcaneus. A. tibialis posterior and a. peronea branch out to nearby bones, muscles, joints, and skin along the way. A. fibularis gives off two important branches for the development of collateral circulation: the common branch and the perforating branch. The first anastomoses with the posterior tibial artery, the second with the anterior tibial artery.

The ankle joint is supplied with blood from the medial and lateral ankle branches. Venous outflow occurs in the deep veins of the lower leg of the same name.

Foot arteries: topography, branches, arterial arches

Foot arteries.

On the back of the foot the dorsal artery of the foot passes, which is a continuation of the anterior tibial artery, located on the bones and having medially from itself the tendon of the long extensor of the thumb, and laterally, the short extensor of the fingers. The dorsal artery of the foot gives off the following branches:

· Ah. tarseae mediales, medial tarsal arteries - to the medial edge of the foot.

A. tarsea lateralis, lateral tarsal artery.

A. arcuata, the arcuate artery, anastomoses with the lateral tarsal and plantar arteries; gives off three dorsal arteries of the metatarsus - the second, third and fourth; each of the metatarsal arteries gives off perforating branches, anterior and posterior.

A. metatarsea dorsalis prima, the first dorsal metatarsal artery, gives off a branch to the medial side of the thumb.

5. Ramus plantaris profundus, a deep plantar branch, is involved in the formation of the plantar arch

Topography. Unpaired and semi-unpaired veins, their tributaries.

Venacavasuperior, superior vena

Topography.

Holotopia: chest cavity

Skeletotopia: line 1 right rib - upper edge of rib 3

Syntopia: Right ascending aorta and right mediastinal pleura, posteriorly trachea, root of the right lung, bronchus, right pulmonary artery and vein, anteriorly right lung, left aortic arch. It is formed from the confluence of the right left brachiocephalic vein. Enters the right atrium

Dermatotopia: right edge of the sternum

The unpaired and semi-azygous veins are the main venous trunks of the posterior mediastinum. They penetrate into it from the retroperitoneal space through the gaps in the diaphragm. The intercostal and esophageal veins flow into them.

The unpaired vein runs along the right side of the vertebral bodies in front of the right posterior intercostal arteries, to the right of the thoracic duct and behind the esophagus. At the level of the IV thoracic vertebra, the unpaired vein crosses the right main bronchus and flows into the superior vena cava.

At the top left there is a non-permanent accessory semi-unpaired vein, v. hemiazygos accessona, which flows into the unpaired vein at the level of VII-VIII thoracic vertebrae. The unpaired and semi-unpaired veins pass the inferior vena cava, carrying blood into the superior vena cava, and in the retroperitoneal space they anastomose with the veins of the inferior vena cava system. As a result, cavo-caval anastomoses are formed.

Brachiocephalic veins, their formation and topography. Ways of outflow of venous blood from the head, neck and upper limbs.

Brachiocephalic veins

Brachiocephalic veins, vv. brachiocephalicae, surrounded by fiber and brachiocephalic lymph nodes, are located immediately behind the tissue of the thymus. These are the first large vessels encountered in the study of the upper mediastinum. vv. brachiocephalicae dextra et sinistra are formed behind the corresponding sternoclavicular joints as a result of the fusion of the internal jugular and subclavian veins.

Topography.

Holotopia: chest cavity

Skeletotopia: sternoclavicular joints

Syntopia: The organ of the upper mediastinum. Left brachiocephalic vein - below the aortic arch, behind the right - the brachiocephalic trunk, behind the left left common carotid artery and left subclavian artery. Right brachiocephalic vein - below the cartilage of the 1st rib, in front of the sternocleidomastoid, sternohyoid and sternothyroid muscles

Dermatotopia: cartilage of the first rib

The inferior and proper thyroid arteries, which are formed from the dense venous plexus at the lower edge of the thyroid gland, flow into the brachiocephalic veins, thymus veins, vertebral veins, cervical and internal thoracic veins.

Venous outflow from the neck and head is carried out through two large paired vessels - the external and internal jugular veins. The vein receives blood from the back of the head behind the auricle, from the skin of the neck above the scapula, the skin of the chin and the front of the neck. It flows into the subclavian or internal jugular vein.

Of particular importance is the internal jugular vein. In the dura mater of the brain there is a system of venous vessels with strong walls, into which the veins flow, draining blood from the brain. They connect with each other, forming a system of venous sinuses of the dura mater. Ultimately, the blood is collected in two sigmoid sinuses, which take the form of the right and left internal jugular veins. In the future, these veins include tributaries that drain venous blood from the skin and muscles, the walls of the nasal and oral cavities, the pharynx, larynx, salivary glands, and thyroid gland. The internal jugular vein eventually joins with the subclavian.

The heart and blood vessels work normally when all arteries are in a healthy state. They entangle human organs with their networks and solve one problem - to ensure the long work of the heart and the body as a whole.

The arterial network of the knee joint can withstand intense blood flow, so it must be strong and reliable. The work of the legs, spine, organs connected with the legs through networks depends on blood circulation. Slowing the flow of blood in the artery or its blockage by blood clots, fat bubbles, cause diseases.

Functional purpose of the network of arteries under the knee

Arteries of the lower limbs

In the circulatory system, the popliteal artery continues the network of arteries of the thigh, which under the knee is divided into the final branches - the anterior and posterior vessels. This is how the knee arterial network is formed, braiding the lower leg and foot.

Functions of the arteries:

The lateral upper one solves the problem of blood supply to the thigh muscles: wide and biceps.
The medial upper blood supply to the thigh muscle, which is called wide in the topography of the arterial network, is located closer to the median plane of the leg.
The middle one solves the problem of blood supply to the ligaments, menisci, synovia, and the capsular component.
The lateral inferior provides blood supply to the calf and plantar muscles.
The medial lower one supplies blood to the gastrocnemius muscles, is an integral part of the branches of the popliteal artery.
The posterior tibial continues the anatomy of the popliteal artery, is located in a special canal under the knee, where the arteries and veins go, and supplies blood to the muscles of the lower leg.

Branches of the arteries of the tibial network under the leg:

Branches of muscles directed to the ankle.
A branch around the fibula supplies blood to adjacent muscles.
The peroneal vessels supply blood to the triceps, long and short muscles. Here the network is distributed into terminal branches running along the ankle and heel and braiding the heel.
The medial plantar branches into superficial and deep vessels. The superficial network entangles the muscle that leads the big toe, the deep one also nourishes the short muscles that bend the fingers.
The lateral plantar on the topography looks like an arch of the sole, extending into the base of the metatarsal bones. Branches entangle the muscles, bones, ligaments of the foot.

Thus, full blood supply to all parts of the lower leg is ensured. This is important for normal functioning and withstanding the load that falls on the legs during the day. The knee is powered by a network of blood vessels that branches off from the anterior tibial artery.

Collaterals in the structure of the knee joint

The collateral connection in the circulatory system under the knees is a special network that has a complex structure in supplying blood to the leg from the knee to the foot. The arteries of the popliteal destination depart from the condyles of the thigh to the knee joint and pass into its upper blood vessels. Branching in front on the surface of the leg makes an anastomosis with the vessels on the lower leg and their branches.

The scheme of collateral connections in the structure of the knee joint includes anastomosis of the lower arteries - paired vessels extending from the popliteal arteries to the upper paired vessels - they make up the arterial network. The structure of the network in its distal part necessarily includes the arteries of the lower leg, which give off a recurrent branch that connects to the permanent recurrent artery.

When it is required to ligate the popliteal artery, the collateral network is the connection of the vessels of the thigh and lower leg. The artificial creation of blood circulation in a collateral way distributes off branches if it is required by treatment after a disease or injury.

The arterial component of the blood supply

The blood supply to the knee joints is provided by arterial networks that are parallel on both legs. A special task is solved by the middle artery of the knee, which is set to nourish the internal structures of the joint - menisci, synovial tissues, cruciate ligaments.

Descending arteries stretch to the knee vessels from the femoral ones, and two recurrent arteries from the tibial ones. The outflow of blood is provided by veins with the same names. All of them are topographically located in such areas of the joint capsule, where the least pressure is provided, so that the blood supply in both directions is carried out at a normal speed.

The function of the legs depends on the normal functions and integrity of the network of the popliteal arteries. If, as a result of a knee injury, an artery rupture occurs, open or closed, it is accompanied by a hemorrhage, which cuts off the nutrition of all leg muscles, all structures of the knee joint. If a hematoma appears on the knee, pain and limping, you should consult a doctor.

Simple research methods are used - external determination of gait, examination of the knee in the patient's supine position, palpation of the knee joint, determination of the state of the subcutaneous vascular network. On palpation of the hematoma, its depth is determined, the possibility of penetration into the internal structures of the knee.

Violation of blood supply due to injuries or diseases leads to atrophy of the muscles of the thigh, lower leg, foot. This is determined visually and by measuring the topography of the movements of the knee.

Treatment of pathologies of the arterial system

Damage is the most common form of pathology of the circulatory system of the legs. These are open cuts, tissue tears as a result of serious injuries, or closed injuries from blows, bruises, sprains. Knee bruises are accompanied by internal hemorrhage, damage to paraarticular tissues.

Home treatment for minor injuries: apply a pressure bandage, apply a cold compress, relieve the sore leg as much as possible. After 2-3 days, you can put warm compresses, take warm baths, UHF procedures, exercise therapy.

In the course of the disease with hemarthrosis, hemorrhage occurs in the internal cavity of the joint, the synovial membrane is damaged, and its vessels are torn. A puncture is required to remove blood from the internal space of the joint and the introduction of 2% novocaine solution into 20 ml. After that, a plaster splint is applied to the sore leg for a week. Next, the doctor prescribes UHF, electrophoresis, exercise therapy. Restoration of the functions of the circulatory system occurs within a month.