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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 79-82

A study of anomalous origin of medial circumflex femoral artery and its significance


1 Department of Anatomy, Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
2 Department of Anatomy, NRI Institute of Medical Sciences, Vishakhapatnam, Andhra Pradesh, India

Date of Web Publication11-Nov-2019

Correspondence Address:
Chakka Sreekanth
Assistant Professor, Department of Anatomy, Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_53_19

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  Abstract 


Background: Femoral artery, a branch of external iliac artery, is the blood supply to the anterior compartment of the thigh. Its branch, medial circumflex femoral artery (MCFA), supplies the head and neck of femur, adductor muscles and the acetabular pad of fat. By virtue of its anatomical location, usually there is a high risk of severing the artery after trauma or during total hip arthroplastic surgeries.
Methods: We studied variations in the femoral artery and its branches in 100 femoral triangles from 50 properly embalmed and formalin-fixed human cadavers, from Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, and NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India.
Results: We observed that the MCFA arose from the common femoral artery in 10% of the cases and from the deep femoral artery in 88% of the cases and was absent in 2% of the cases.
Conclusions: The MCFA variability must be taken into account by surgeons, especially during orthopaedic interventions in the region of the hip to prevent iatrogenic injury to the circulation of the femoral head.

Keywords: Deep femoral artery, femoral artery, lateral circumflex femoral artery, medial circumflex femoral artery


How to cite this article:
Sreekanth C, Ravindranath G, Venkataramana C. A study of anomalous origin of medial circumflex femoral artery and its significance. J Clin Sci Res 2019;8:79-82

How to cite this URL:
Sreekanth C, Ravindranath G, Venkataramana C. A study of anomalous origin of medial circumflex femoral artery and its significance. J Clin Sci Res [serial online] 2019 [cited 2019 Dec 16];8:79-82. Available from: http://www.jcsr.co.in/text.asp?2019/8/2/79/270751




  Introduction Top


The lateral and medial circumflex femoral arteries are typically the largest branches of the profunda femoris artery, although they do not always arise from this vessel; either or both may arise as branches of the femoral artery itself above the origin of profunda. In any case they originate in the femoral triangle and whether they arise from the profunda or common femoral artery, they may share a common stem or have separate origins.[1] The medial circumflex femoral artery (MCFA) typically arises from the medial or posteromedial aspect of the profunda or femoral and runs posteriorly, or downward and then posteriorly, to leave the femoral triangle between the iliopsoas and pectineus muscles, adductor brevis and winds around the medial side of femur between obturator externus and adductor brevis and then continues between quadratus femoris and upper border of adductor magnus.[2] This artery was also known as circumflexa femoris interna or arteria circumflexa femoris medialis.[2]

As the deep branch reaches the anterior surface of quadratus muscle, it divides into two terminal branches as ascending and transverse branches. The femoral head gains its blood supply from lateral epiphyseal vessels which are the branches of the posterior superior retinacular vessels of the MCFA. Posteroinferior arteries are sometimes given by MCFA to the femoral head and neck and posterior arteries to the neck of femur. In case of ischaemic necrosis of the femoral head of unknown origin, angiography may help to rule out the query. Trochanteric and intertrochanteric osteotomies, iatrogenic vascular necrosis of the head of femur, reconstructive surgery of the hip and fixation of acetabular fractures through the posterior approach compel us to know the detailed knowledge of anatomy of MCFA.


  Material And Methods Top


In the present study, total 100 femoral triangles from 50 properly embalmed and formalin-fixed human cadavers, from various medical colleges of Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, and NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India, were dissected meticulously as per the Cunningham's manual[3] during the educational dissection for undergraduate medical students.

The anterior superior iliac spine and pubic tubercle were identified by deep palpation, and then, an oblique incision has been made below the inguinal ligament. Then, the detachment of the skin and the subcutaneous tissue was made. Care was taken to preserve the great saphenous vein passing over the medial side and penetrating a defect of the deep fascia known as fossa ovalis where the lateral margin called falciform margin to drain into the femoral vein. After that, the deep fascia was removed as soon as the anterior compartment muscle could be inspected. The anterior compartment includes the quadriceps femoris, sartorius, pectineus, iliacus and iliopsoas (psoas major and minor). The quadriceps femoris has four heads which are rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Organisations of these previous muscles give a triangle known as femoral triangle which is formed by inguinal ligament superiorly, sartorius laterally and adductor longus medially. The latter muscle forms the floor of this triangle partially and completed by iliopsoas and pectineus. The femoral artery passes below the inguinal ligament as a continuation of the external iliac artery and terminates as popliteal artery at the adductor hiatus. The femoral artery is known as common femoral artery by a radiologist. Therefore, the common femoral artery bifurcates into superficial and deep femoral (profunda femoris) arteries. Hence, the superficial femoral artery is a segment starting from the site of the femoral artery ending at adductor hiatus as popliteal artery. The superficial femoral artery has to be traced till termination as popliteal artery. The typical bifurcation of the femoral artery is into superficial and deep femoral arteries as the profunda femoris artery usually gives medial and lateral femoral circumflex arteries. The medial femoral circumflex branch runs medially and posteriorly between pectineus and iliopsoas and divides into anterior and posterior branches. To clarify this artery, the femoral vein and its tributaries have to be got rid of it. During medial femoral circumflex vein removal, attention has to be paid to avoid the unnecessary extraction of the medial femoral circumflex branch. The medial femoral circumflex branch is a standard branch of the profunda femoris artery, but a possibility of this branch arises independently or dependently (same trunk) from the common femoral artery and superficial femoral artery. Furthermore, MCFA may arise with the superficial and deep femoral arteries. It may also arise with the previous two arteries and lateral circumflex femoral artery (LCFA). The variations thus observed were recorded and photographed [Figure 1], [Figure 2], [Figure 3].
Figure 1: The absence of medial circumflex femoral artery on the right side. FV = Femoral vein; PFA = Profunda femoris artery; SM = Sartorius muscle, FA = Femoral artery

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Figure 2: The medial circumflex femoral artery arising from the common trunk of the femoral artery with the deep femoral artery on the left side. MCFA = Medial circumflex femoral artery; DFA = Deep femoral artery; LCFA = Lateral circumflex femoral artery

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Figure 3: Cadaver photograph showing origin of deep femoral artery. FA = Femoral artery; DFA = Deep femoral artery; FV = Femoral vein

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  Results Top


Among 50 of the adult limb extremities, variations were observed only in 12 limbs. We observed that the MCFA arose from the common femoral artery in 10 cases (10%), from the deep femoral artery in 88 of the cases (88%) and was absent in 2 cases (2%). On the left side in 3 cases (3%), the MCFA arose from the common trunk of the femoral artery with the deep femoral artery at a distance of 33.1 mm from the inguinal ligament. The left MCFA passed between pectineus and adductor brevis and, then on the anterior aspect of the pectineus, passed posterior to the femoral vein and finally entered into the gap between pectineus and adductor brevis and terminated by dividing into ascending and transverse branches. The origin of the deep femoral artery was 40.9 mm distal to the inguinal ligament. The origin of the LCFA was 23.8 mm away from the origin of the deep femoral artery and 23.1 mm away from the origin of the MCFA. It arose from the common femoral artery along with external pudendal artery in 7 cases (7%). In one case, the MCFA cam along with the femoral artery just below the inguinal ligament and measurement was difficult. In two cases (2%), the MCFA is totally absent.[1]


  Discussion Top


Radiologists and clinical practitioners describe that the part of the femoral artery proximal to the origin of the profunda femoris is often termed the common femoral artery, while that distal to the origin of the profunda is termed the superficial femoral artery.[4],[5],[6] The deep femoral artery (the profunda femoris artery) usually gives medial and lateral femoral circumflex arteries. Furthermore, MCFA may arise with the superficial and deep femoral arteries. Very rarely, it may be absent.

Various types of origin of the MCFA were as follows: (i) from deep femoral artery (72.5%), (ii) from common femoral artery (27.5%), from LCFA (0.01%), and total absence.[7],[8],[9] The variability of the MCFA in origin and its level in relation to deep femoral and medial circumflex femoral arteries is due embryologic development of the primitive plexus of femoral trees and the primitive axial artery regression either completely or incompletely.

The MCFA is the main artery that supplies the femoral head and neck and it is usually injured during femoral neck fractures. Therefore, clinicians and surgeons who are interested in this region should be familiar with the variations of this artery. Aseptic necrosis of the femoral head could occur after femoral neck fractures.[10],[11] In literature, the origin variability of MCFA has been divided into origin from the deep femoral artery (18%–77.8%) and from the femoral artery (22.2%–83.3%).[12],[13]

In the present study, MCFA was found to be arising most frequently from the common femoral artery. Further, MCFA was also documented to be 'absent', which is a very rare anomaly. In such cases, the territory of MCFA is supplied by branches of the first perforating artery, obturator artery and gluteal artery. The femoral artery and its branching pattern show huge variations, so prior angiography is essential before attempting any surgical procedures.

Acknowledgements

We thank people who donated their bodies for dissection and research work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hollinshead WJ. Anatomy for Surgeon's: The Back and Limbs. Vol. 3. New York: Medical Book Department of Harper and Brothers; 1958. p. 705-42.  Back to cited text no. 1
    
2.
Chand I, Singh B. Arteria profunda femoris and its variations. Ind Med Gaz 1951;86:248-50.  Back to cited text no. 2
    
3.
Romanes GJ. Cunningham's manual of practical anatomy: Upper and lower limbs. 15th ed., Vol. 1. Oxford: Oxford University Press; 2009. p. 129-44.  Back to cited text no. 3
    
4.
Standring S. Pelvic girdle, gluteal region and thigh. In: Gray's anatomy: The anatomical basis of clinical practice. 41th edition. London: Elsevier; 2016. p. 1367-70.  Back to cited text no. 4
    
5.
Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000;82:679-83.  Back to cited text no. 5
    
6.
Dixit DP, Mehata LA, Kothari ML. Variations in the origin and course of profunda femoris. J Anat Soc India 2001;50:6-7.  Back to cited text no. 6
    
7.
Lipchutz BB. Studies on the blood vascular tree, 1, A composite study of the femoral artery. Anat Rec 1916:10:361-70.  Back to cited text no. 7
    
8.
Clarke SM, Colborn GL. The medial femoral circumflex artery: Its clinical anatomy and nomenclature. Clin Anat 1993;6:94-10.  Back to cited text no. 8
    
9.
Tanyeli E, Uzel M, Yildirim M, Celik HH. An anatomical study of the origins of the medial circumflex femoral artery in the Turkish population. Folia Morphol (Warsz) 2006;65:209-12.  Back to cited text no. 9
    
10.
Samarawickrama MB, Nanayakkara BG, Imalagu-narathna KW, Ishantha DG, Walawage UB. Branching pattern of the femoral artery at the femoral triangle: A cadaver study. Galle Med J 2009;14:31-4.  Back to cited text no. 10
    
11.
Siddharth P, Smith NL, Mason RA, Giron F. Variational anatomy of the deep femoral artery. Anat Rec 1985;212:206-9.  Back to cited text no. 11
    
12.
Tomaszewski KA, Henry BM, Vikse J, Roy J, Pękala PA, Svensen M, et al. The origin of the medial circumflex femoral artery: A meta-analysis and proposal of a new classification system. PeerJ 2016;4:e1726.  Back to cited text no. 12
    
13.
Al-Talalwah W. The medial circumflex femoral artery origin variability and its radiological and surgical intervention significance. Springerplus 2015;4:149.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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